非骨水泥长柄假体结合同种异体颗粒骨植骨在股骨翻修骨缺损重建中的应用

目的 回顾性分析股骨髓内同种异体颗粒骨打压植骨结合非骨水泥长柄假体在髋关节翻修术中股骨侧骨缺损修复应用的近期临床效果.方法 2003年7月至2009年6月对27例股骨侧骨缺损患者采用同种异体颗粒骨打压植骨,其中男性15例,女性12例,年龄47～78岁,平均67岁.失败原因:骨溶解、无菌性松动20例,全髋关节置换术后假体周围感染二期翻修7例.按Paprosky分型标准,Ⅱ型骨缺损3例,Ⅲ型骨缺损2l例,Ⅳ型骨缺损3例.术中均采用同种异体颗粒骨打压植骨、非骨水泥翻修柄植入.定期随访复查,包括临床、影像学评估,观察假体有无松动、下沉,植入骨活化替代情况以及假体周围骨折等并发症.Harris评分术前平均43分(37～62分).结果 23例患者获得随访,随访时间3～47个月,平均26.4个月.术后末次随访时.Harris评分平均83分(67～97分).术中2例发生股骨大转子骨折,无一例发生术后假体周围骨折等并发症.1例术后发生关节脱位,1例发生深静脉血栓,1例术后2周发生急性感染,经扩创、置管冲洗、抗感染治疗成功保留假体;发生异位骨化1例,Brooker Ⅰ级.影像学所有患者股骨柄中置,无内翻或外翻,随访期内无一例发生股骨柄移位(内翻或外翻角度变化>3°).23例患者显示至少Ⅰ区股骨髓内移植骨与周围骨或与股骨柄整合.4例发生股骨柄假体下沉,平均下沉3.3 mm(2～6 mm).结论 股骨侧翻修中,良好的股骨髓内同种异体颗粒骨打压植骨结合合适的非骨水泥延长柄股骨假体,可以修复关节置换术后各种原因所导致股骨骨缺损、重建股骨完整性,具有很好的近期临床疗效.但中远期临床效果尚待进一步观察.

Impaction morselized allografting combined with cementless long stem for femoral defects in femoral component revision

Objective To retrospectively analyze the clinical and radiological results of the impaction morselized allografting combined with cementless long stem for femoral component revision in patients with significant bone loss. Methods From July 2003 to June 2009, 27 patients (27 hips) underwent revision hip arthroplasty in femurs with bone defect using impaction allografting and cementless components. There were 15 male and 12 female with mean age of 67 years. According to the Paprosky classification system, the bone defects in femur were classified into type Ⅱ in 3 cases, type Ⅲ in 21 cases and type Ⅳ 3 cases. The patients were followed up postoperatively to observe the clinical and radiological results, and if there had the stem subsidence, periprothetic fracture, infection and other complications. Results Twenty-three patients were followed up. The mean follow-up time was 26 months. Harris score improved from 43 points pre-revision to 83 points at the final follow-up. No femoral stem loosening and failure occurred. There were 4 stem with a mean 3. 3 mm subsidence. One case had an acute infection after revision and treated successfully by debridement and drainage, antibiotics. No stem need further revision. Radiographic analysis showed all the revised stem was stable, and graft incorporation was seen in at least 1 zone in 100% of the femurs. Conclusion The results of this study demonstrates that femoral support and vigorous impaction grafting combined with cementless long stem results in an good intermediated-term clinical effects.