全髋翻修髋臼骨缺损中颗粒打压植骨的应用

背景：髋臼重建植骨分为颗粒植骨、结构植骨和混合植骨，而颗粒骨由于制作简便、愈合时间短等优点而被大量使用。 目的：探讨全髋人工关节翻修中髋臼AAOSIII型骨缺损颗粒打压植骨技术的应用要点和临床效果。 方法：16例髋关节翻修AAOSIII骨缺损患者采用单纯颗粒打压植骨技术、结合金属器械或结构植骨处理髋臼AAOSIII型骨缺损。对比治疗前及治疗后定期随访的髋关节Harris评分及影像学资料，评估颗粒打压植骨对该型髋臼骨缺损的治疗效果。 结果与结论：按照治疗后3，6，12个月及每半年周期随访中，16例患者髋关节疼痛症状均得到明显缓解，并恢复行走功能。16例患者治疗后Harris髋关节功能评分由治疗前平均48.00分提高到84.94分(P < 0.01)，其中优5例，良8例，可2例，差1例，优良率为81%，患者满意率为94%。16例患者术后X射线片示髋臼旋转中心均恢复(接近)正常，臼杯骨性覆盖良好，植骨颗粒获得放射学骨整合，臼杯假体未发生移位，假体植入物未发生位置改变或断裂现象。结果提示颗粒打压植骨技术修复翻修髋臼AAOSIII型骨缺损，有效重建了髋臼的骨性结构，保留并恢复了髋臼的骨量，具有良好的技术优势和临床疗效。

Impaction bone grafting with morselized bone in total hip revision for acetabular deficiency

BACKGROUND:Bone graft for acetabular reconstruction includes morselized bone graft, structural bone graft and hybrid bone graft, and the morselized bone has been widely used because of the advantages of simple production and short healing time.      OBJECTIVE:To explore the key technologies and clinical effect of impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency. METHODS: Sixteen cases of AAOS Ⅲ acetabular deficiency were treated with impaction bone grafting with morselized bone combined with metal devicesor constructive bone grafting. The hip Harris scores and radiographic data were compared before and after treatment. The effect of impaction bone grafting with morselized bone on acetabular deficiency was assessed.  RESULTS AND CONCLUSION:All the patients were followed-up at 3, 6, 12 months after surgery and every half a year successively. The pain of hip joints after operation was relieved significantly and the walking function was restored. The hip Harris score was improved from 48.00 points before surgery to 84.94 points after surgery (P < 0.01). Five cases were graded as excellent, eight cases as good, two cases as average, and one case as poor. The excellent and good rate was 81%, and the satisfying rate of the patients was 94%. The post-operative X-ray films of all the 16 patients showed that the acetabular rotation centers were recovered (near) to normal and the acetabular cups were covered well by bone. The grafting bone particles got radiological osseointegration and the acetabular cup prosthesis did not displaced, and no displacement and breakage happened to the metal devices. Impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency can effectively reconstruct the acetabular bone structure, retain and restore the acetabular bone mass, and it has good technical advantages and good clinical effects.