结构性植骨治疗全髋关节置换术中髋臼骨缺损的疗效观察

[目的]探讨结构性植骨治疗全髋关节置换术中髋臼骨缺损的疗效.[方法]对2008年1月至2014年12月在本院骨科诊治且获得随访的31例髋关节置换术中进行结构性植骨患者的临床资料.随访5.8(4~10)年,手术原因:发育性髋关节发育不良CroweⅡ型9例9髋,CroweⅢ型16例16髋,髋臼骨折术后感染并股骨头坏死、髋臼缺损6例6髋.25例采用自体股骨头行结构性植骨,6例采用同种异体结构性植骨,观察临床疗效.[结果]所有患者切口均一期愈合,未出现感染、血栓形成病例,未出现血管、神经损伤病例.所有病例均不需扶拐行走,VAS评分由术前的(6.2±1.3)分降低到随访时的(1.6±0.3)分(P<0.05),Harris评分由术前的(56±6.2)分提高至随访时的(87±4.5)分(P<0.05).4髋偶尔仍有轻度疼痛,无中、重度疼痛病例,无大腿疼痛病例.23例步态正常,8例轻度跛行.31例患者均对手术效果表示满意.所有病例植骨块均与髂骨骨床骨性愈合,但其中2髋可见植骨块部分吸收,2髋植骨块与骨床间可见少许不连续透亮带.未出现螺钉断裂及植骨块移位病例,未出现假体松动而需再次翻修病例.术后早期外展角、前倾角与术后末次随访外展角及前倾角无差异(P>0.05).[结论]把握好手术适应证及遵循操作规范,结构性植骨治疗全髋关节置换髋臼骨缺损中期疗效满意,值得临床推广应用.

Effect of Structural Bone Grafting on Acetabular Bone Defect in Total Hip Replacement

[Objective]To explore the efect of structural bone grafting in the treatment of acetabular bone de-fect in total hip replacement.[Methods]From January 2008 to December 2014,the clinical data of 31 cases of structural bone graft during hip replacement were analyzed.The follow-up period was 5.8(4-10)years.The causes of operation were as follows;9 cases of developmental dysplasia of Crowe Ⅱ type with 9 hips,16 cases of Crowe Ⅲ type with 16 hips,6 cases of acetabulum fracture with infection,necrosis of femoral head and acetabulum defect with 6 hips.25 cases underwent structural bone grafting with autologous femoral head and 6 cases with structural bone grafting with allograft to observe the clinical efect.[Results]The incision of all patients healed in one stage.without infection,thrombosis,vascular and nerve injury.The VAS score decreased from(6.2±1.3)before operation to(1.6±0.3)during follow-up(P<0.05).The Harris score increased from(56±6.2)before operation to(87±4.5)during follow-up(P<0.05).There were no cases of moderate or severe pain,and no cases of thigh pain.23 cases had normal gait and 8 cases had mild claudication.All the 31 patients were satisfied with the results of the operation.In all cases,the bone graft healed with the ilium bone bed,but the bone graft was partially absorbed in 2 hips,and there were some discontinuous transparent bands between the bone graft and the bone bed in 2 hips.There were no cases of screw fracture and bone graft displacement,no cases of prosthesis loosening and need to be repaired again.There was no difference in abduction angle and anteversion angle between early postoperative and last follow-up(P>0.05).[Conclusion]The indication of the operation was well grasped and the operation standard was followed.The structural bone graft was satisfactory in the treatment of acetabular bone defect in total hip arthroplasty in the midterm,which is worthy of elinical application.