全髋关节翻修术中骨缺损的重建

目的观察异体骨移植在全髋关节翻修术中骨缺损重建的临床价值。方法对1996年6月～2000年12月收治的19例全髋关节翻修术的患者进行回顾性分析,其中男11例,平均年龄66.5岁,女8例,平均年龄63.2岁。髋臼骨缺损类型为Ⅰ型2髋,Ⅱ型10髋,Ⅲ型4髋;股骨骨缺损类型为Ⅰ型3髋,Ⅱ型11髋,Ⅲ型2髋;髋臼及股骨无明显缺损患者4例。骨缺损重建方法包括髋臼结构性植骨3例,髋臼内压紧颗粒骨植骨3例,髋臼内金属网垫植骨3例,髋臼、股骨压紧颗粒骨植骨6例7髋,股骨结构性植骨3例,金属网加强颗粒骨植骨2例,股骨压紧颗粒骨植骨4例,4例患者未行植骨。应用Harris评分标准及X线分别评价翻修术后临床转归及移植骨愈合情况。结果19例患者平均随访46个月(6～68个月),随访患者的Harris评分由翻修术前的平均42.7分(24～59分)增至术后的平均82.7分(55～99分),15例16髋异体骨植骨患者X线片显示1例髋臼结构性植骨部分吸收,髋臼松动,须行翻修术;1例髋臼松动,无症状;3例有X线透亮带。无感染发生。结论全髋关节翻修术中,根据骨缺损类型,选用相应的异体骨移植是一种可靠而有效的方法。

Reconstruction of bony defect in revision surgery following total hip arthroplasty

Obiective To evaluate the value of allograft bone for acetab ular and femoral reconstruction in THA revision surgery. Methods A total of 19 p atients underwent reconstruction of acetabular and proximal femoral bone defects from June 1996 to December 2000 were reviewed. Eleven of the patients were men and 8 women with a mean age of 66.5 years and 63.2 years respectively at the t ime of resision surgery. According to AAOS system, the acetabular bone defects w ere classified into type I in 2 hips, type II 10 hips and type III 4 hips, and o n the femoral side, there were type I in 3 hips, type II 11 hips and type III 2 hips respectively. The reconstruction of bone defect of acetabulum included stru ctural allograft in 3 hips, impacted morselized allograft in 3 hips, and metal w ire mesh with morselized allograft in 3 hips. In all 3 of femoral segemental def ects, the reconstructions of the proximal femoral bone defects were done with st ructural allografts. Metalwire mesh with morselized allograft for femoral bone d efects were performed in 2 cases and morselized allogratts alone for femoral bon e defects in 4 cases; both acetabular and femoral bone defects were reconstruct ed with impacted morselized allografts in 6 cases (7 hips), and 4 patients with no bone grafts; Harris score system and radiograph were used for the final eva luation. Results Ninteen patients were followed up for an average period of 46 m onths (ranges, 6 to 68 months), Harris score improved from 42.7 points pre rev ision to 82.7 points at final follow up, the incorporation of allografts bone in 15 patients (16 hips) were noticed radiographically in all but one hip was fo und reabsorption of the structural allograft and radiolucents were found in the other 3 patients. No infection was encountered in this series. Conclusion If th e different types of bone defects were properly identified and suitable allogrft s adopted, reconstruction of bone defects with allografts during the THA revisi on surgery is a useful and reliable method.