THA翻修术中髋臼骨缺损的处理策略

目的探讨全髋关节置换术（THA）翻修术中髋臼骨缺损重建的方法及疗效。方法回顾1999年6月至2007年5月,在THA翻修术中处理的髋臼骨缺损112例（117髋）。根据Saleh KJ的改良分型法,Ⅰ型缺损14髋、Ⅱ型缺损26髋、Ⅲ型缺损47髋、Ⅵ型缺损16髋、Ⅴ型缺损14髋。分别采用大直径非骨水泥假体臼、非骨水泥假体臼＋松质颗粒植骨、骨水泥假体臼＋Cage＋松质颗粒植骨和骨水泥假体臼＋定制型假体＋松质颗粒植骨,对不同类型骨缺损进行修复。术后定期随访,采用Harris方法评估髋关节功能,根据X线片判断假体是否有松动,移植骨是否愈合。结果随访时间平均45（13～118）个月。除4髋因脱位或假体周围骨折进行再翻修外,其余效果良好。术后Harris评分平均86.2分,较术前平均改善40.6分。X线片无假体松动下沉,可见移植骨-宿主骨交界处有连续性小梁骨通过。结论在THA翻修术中,大部分髋臼骨缺损可使用较大型号非骨水泥假体或加松质颗粒植骨进行修复;对于影响假体稳定性的较大缺损,使用骨水泥假体臼＋Cage＋松质颗粒植骨的方法可获得良好效果;定制型假体在处理严重髋臼骨缺损中有具独特优势,有良好的临床应用前景。

Treatment of acetabular deficiencies in revision of total hip arthroplasty

Objective To explore the treatment and effect of the acetabular deficiencies in revision of total hip arthroplasties. Methods 117 revision total hip arthroplasties（112cases） in conjunction with acetabular deficiencies were followed up.We improved Saleh KJ system,according to it,typeⅠ14 hips,typeⅡ26 hips,typeⅢ47 hips and typeⅣ16 hips,and typeⅤ14 hips.We used acetabular enlarging and rasping,morselized cancellous bone grafting,Cage or custom - made prosthesis respectively or combinedly,depending on defect types.The noncemented or cemented fixed methods were used.The Harris Hip score was used to evaluate the hip functions.The X - ray was used to evaluate the loosening of prosthesis and the union of the bone graft.Results The mean follow - up was 45 months（13～118 months）.All hips but four that accepted re - revision for dislocation or peristhetic fratures acquired good results.The mean Harris Hip Score was 86.2 points,40.6 pionts higher than preoperative.In X - ray,there was no prosthetic loosening and showed evidence of trabecular bridging between the graft and host bone.Four hips.Conclusion In THA revision, the majority acetabular deficiencies could be treated by large diameter prosthesis or plus with morselized cancellous bone graft.For large deficiencies that influence the prosthesis stability,the choice of morselized cancellous bone draft, plus Cage and cemented prosthesis may acquire good effect.The custom - made prostheses have distinctive advantages to serious bone defect,and have a desirable clinical prospect.