人工全髋关节置换术中髋臼骨缺损的重建

目的 探讨人工全髋关节置换术中各种髋臼骨缺损的特点与重建方法.方法 1998年5月至2008年8月对获得随访的行初次全髋关节置换或翻修的37例(37髋)髋臼缺损患者的临床资料进行回顾性分析,依据AAOS分型采取颗粒性或结构性植骨、生物或骨水泥髋臼假体以及钛网或加强环置入等方法对骨缺损进行重建.术前Harris评分(42±8)分.术后采用Harris评分判断髋关节的功能改善情况,复查X线片了解移植骨愈合及假体在位情况.结果 AAOS Ⅰ型9例,Ⅱ型13例,Ⅲ型15例.颗粒性植骨24例,结构性植骨6例,混合性植骨7例;生物型假体21例,骨水泥型假体16例.平均随访时间53.7个月.术后Harris评分(87±5)分,与术前比较,差异具有统计学意义(P<0.05).移植骨在最后一次复查时均已愈合或基本愈合.结论 对于AAOS Ⅰ型、Ⅱ型等简单的髋臼骨缺损,颗粒性或结构性植骨结合生物型髋臼假体就可以获得很好的初始稳定性,而对于AAOSⅢ型等较严重的缺损,则应行结构性植骨或附加钛网及加强环等重建髋臼.其短、中期疗效是令人满意的.

Reconstruction of acetabular bone deficiency in total hip arthroplasty

Objective To discuss the characteristics and reconstruction strategies of acetabular bone deficiency in total hip arthroplasty in order to find the optimal resolution for this clinical puzzle. Methods Clinical and radiological materials of 37 patients (37 hips) with acetabular deficiency who underwent primary or revision total hip arthreplasty were analyzed retrospectively from May 1998 to August 2008. According to the common classification system for acetabular bone deficiency-the AAOS classification system, the acetabular bone defect was reconstructed using morsellized or structural bone grafting, accessory acetabular hardware (ring, cup or cage) together with cemented or cementless acetabular component respectively. All patients were followed up regularly to assess their hip function improvement by measuring the Harris hip score and to find out the grafting bone healing, absorption and position of the prosthesis by plain radiographic examination. Results There were 11 primary and 26 revision total hip arthroplasty. There were 9 hips of AAOS-type Ⅰ defect, 13 of type Ⅱ and 15 of type Ⅲ. Morsollized bone grafting was used in 24 cases, bulk structural bone grafting in 6 cases and mixed bone grafting in 7 cases. Twenty-one patients used cementless prosthesis and 16 used cemented prosthesis. The average follow-up period was 53.7 months (6.5 to 130.5 months), the average preoperative Harris hip score was 42±8 with contrast to 87±5 of post-operation. Statistically significant difference was found according to t-test with P value less than 0.05. Major or complete healing of grafting bone was obtained at the latest follow-up. Conclusions Acetabular bone defect during primary or revision total hip arthroplasty should be reconstructed according to its characteristics and severity. For relatively simple AAOS type Ⅰ and type Ⅱ cases, morsellized or bulk structural bone grafting together with cementless prosthesis could achieve favorable initial stability, but for more severe AAOS type Ⅲ cases, bulk structural bone grafting with accessory reinforcement hardware would be necessary. Though the early and mid-term results of the above strategies are satisfied, the long term outcome still require further study.