植骨重建在节段型髋臼缺损的全髋关节置换中的应用

目的　评价髋臼植骨重建在节段型髋臼缺损的全髋关节置换术 (total hip arthroplasty,THA)中的应用和效果。　方法　回顾分析 1991年～ 2 0 0 0年 ,采用自体骨移植重建髋臼治疗髋臼节段型缺损的 THA 39例 ,男 2 5例 ,女 14例。年龄 34～ 6 2岁 ,平均 4 5 .2岁。缺损为髋臼发育不良 2 1例 ,股骨颈骨折股骨头坏死、髋脱位 14例 ,髋臼骨折骨关节炎 4例。将切除股骨头或髂骨按缺损情况制成楔形置入缺损处 ,采用骨水泥 (12例 )或非骨水泥 (2 7例 )假体。术前Harris评分 18～ 5 0分 ,平均 38.1分。　结果　 2 4髋获随访 2～ 10年 (平均 6 .7年 )。术后肢体长度平均增加 2 .4 cm。植骨愈合良好 ,随访中未见假体松动。术后 1年和最后随访时平均 Harris评分分别为 92 .1和 86 .3分 ,与术前 Harris评分比较有统计学意义 (P<0 .0 5 )。术后 1年和最后随访时优良率分别为 91.7%和 83.3%。　结论　采用自体骨重建存在节段型缺损的髋臼 ,对术后髋关节功能的稳定性具有重要意义。

THE APPLICATION OF RECONSTRUCTION WITH AUTOGRAFT IMPLANTATION IN TOTAL HIP REPLACEMENT WITH REGIONAL ACETABULAR DEFICIENCY

Objective To evaluate the effect of reconstruction with autograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. Methods From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62(45.2 on average). There were 21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis(10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedge shaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA.Of all the cases, 24 were followed up 2 to 10 years(6.7 years on average). Harris scores before operation were 18 to 50(38.1 on average). Results The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Compared with the scores before the operation, the average Harris scores after the operation were 92.1( P <0.01)and 86.3( P <0.05) in the one year and the latest follow up respectively. The rates for the good were 91 7% and 83 3% in the one year and the latest follow up respectively.Conclusion The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency. It is of significance in maintaining a long term function in the replaced hip.