混合植骨技术结合髋臼加强杯或钛网杯重建髋臼严重骨缺损

 目的 探讨自体骨和异体冷冻干燥骨混合植骨方法在治疗髋臼严重骨缺损中恢复髋臼骨量的作用，评价混合植骨技术结合髋臼加强杯或钛网杯重建髋臼的临床效果。方法 1999年4月至2007年12月，采用自体骨和异体冷冻干燥骨混合打压植骨结合髋臼加强杯或钛网杯对髋臼严重骨缺损18例19髋进行重建。男8例，女10例；年龄33~76岁，平均64.7岁。全髋关节置换术后髋臼周围骨溶解导致髋臼假体松动而行翻修术17例，髋臼发育不良行髋臼截骨术后继发髋关节骨关节炎行全髋关节置换1例。Paprosky ⅡB型骨缺损5髋，Paprosky ⅡC型2髋，Paprosky ⅢA型6髋，Paprosky ⅢB型6髋。结果 全部病例随访3.6~12.3年，平均6.5年。Harris髋关节评分由术前平均(38.7±9.6)分提高至末次随访(87.6±7.8)分。术后3~6个月X线检查可见髋臼植骨区骨长入，1年后植骨区骨整合良好。随访期间未发现髋臼再松动病例。1例出现髋臼聚乙烯明显磨损，髋关节旋转中心上移。结论 自体骨和异体冷冻干燥骨混合打压植骨可有效恢复髋臼骨量，植骨中加入的自体骨可促进植骨区骨长入，混合植骨方法结合髋臼加强杯或钛网杯固定治疗髋臼严重骨缺损疗效确切。

Management of massive acetabular bone defects using a mixture of autograft and freeze-dried allograft bone combined with acetabular scaffold

Objective To investigate the role of hybrid bone grafting using autograft and freeze-dried allograft bone in restoration of acetabular bone defect, as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency. Methods Between April 1999 to December 2007, 18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold. There were 8 males and 10 females, aged from 33 to 76 years (average, 64.7 years). The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia. There were 5 cases of PaproskyⅡB defect, 2 PaproskyⅡC defect, 6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect. Results All patients were followed up for 3.6 to 12.3 years (average, 6.5 years). Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up. According to X-rays, bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3 to 6 months postoperatively, and effective bone incorporation was achieved in all cases one year postoperatively. Polyethylene wear occurred in one case. Acetabular component loosening was not found at final follow up. Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect. Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation. Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.