异体皮质骨支撑植骨在髋关节股骨翻修术中的应用

目的探讨异体皮质骨支撑植骨在髋关节股骨翻修术中应用的适应证及临床效果。方法从2001年10月至2007年12月，笔者对41例股骨严重骨缺损的患者在髋关节翻修术中应用了同种异体皮质骨支撑植骨。主要在以下三种情况下使用，一是采用延长股骨粗隆截骨（ETO）取股骨假体，而患者近端骨质疏松或原有严重的骨缺损，采用远端固定假体翻修，为增加股骨近端的强度或增加ETO后股骨近端的稳定性而采用，这类患者共20例；二是在采用打压植骨进行股骨重建时，因为股骨存在有节段性缺损，或因取股骨远端骨水泥而进行股骨开窗造成股骨节段性缺损时，为了封闭骨缺损，使其成为包容性缺损而采用，这类患者共6例；三是在有严重股骨骨质疏松的患者出现股骨骨折时采用，这类患者共15例。笔者进行了平均37个月（6～72个月）的随访。结果所有同种异体皮质骨在术后12个月可以看出有与宿主骨结合的征象，假体固定稳定。未发生感染、排异反应或假体松动征象，髋关节Harris评分从术前平均38分增加到术后的88．1分。结论异体皮质骨支撑植骨在某些股骨翻修情况下有其特殊的需要，能够作为生物接骨板提供机械稳定性和生物稳定性，目前有不可替代的作用。

Application of the cortical strut allograft for the femoral revision in the total hip arthroplasty

Objective To study the role of the cortical strut allograft in femoral revision of THA and it＇ s result. Methods Cortical strut allografts were used in 3 different conditions of 41 cases of revision THA from October 2001 to December 2007. One is using the cortical strut allograft to enhance bone quality of the proximal part femoral combining with MP prostheses in 20 cases, the second condition is using with impaction bone grating technique in 6 cases and the third one is using in the treatment of peristhetic femoral fracture in 15 cases . We ＇ ve got an average of 37 months （ 6 - 72 months ） of follow-up. Results All the allografts showed the signs of incorporating with the host bone in 12 months after the operation. The femoral prostheses were stable without any signs of the infection and loosening. The Harris Hip Score was increased from average of 38 points pre-ope rations to average of 88. 1 points post-operations. Conclusions Cortical strut allograft could provide a good method for some femoral revisions in total hip arthroplasty both in mechanical and biological stability as the biological bone plates.