CAJ | 학술논문

目的探讨自体骨和异体冷冻干燥骨混合植骨方法在治疗髋臼严重骨缺损中恢复髋臼骨量的作用,评价混合植骨技术结合髋臼加强杯或钛网杯重建髋臼的临床效果.方法 1999年4月至2007年12月,采用自体骨和异体冷冻干燥骨混合打压植骨结合髋臼加强杯或钛网杯对髋臼严重骨缺损18例19髋进行重建.男8例,女10例;年龄33～76岁,平均64.7岁.全髋关节置换术后髋臼周围骨溶解导致髋臼假体松动而行翻修术17例,髋臼发育不良行髋臼截骨术后继发髋关节骨关节炎行全髋关节置换1例.PaproskyⅡB型骨缺损5髋,PaproskyⅡC型2髋,PaproskyⅢA型6髋,PaproskyⅢB型6髋.结果全部病例随访3.6～12.3年,平均6.5年.Harris髋关节评分由术前平均(38.7±9.6)分提高至末次随访(87.6±7.8)分.术后3～6个月X线检查可见髋臼植骨区骨长入,1年后植骨区骨整合良好.随访期间未发现髋臼再松动病例.1例出现髋臼聚乙烯明显磨损,髋关节旋转中心上移.结论自体骨和异体冷冻干燥骨混合打压植骨可有效恢复髋臼骨量,植骨中加入的自体骨可促进植骨区骨长入,混合植骨方法结合髋臼加强杯或钛网杯固定治疗髋臼严重骨缺损疗效确切.
목적 탐토자체골화이체냉동간조골혼합식골방법재치료관구엄중골결손중회복관구골량적작용,평개혼합식골기술결합관구가강배혹태망배중건관구적림상효과.방법 1999년4월지2007년12월,채용자체골화이체냉동간조골혼합타압식골결합관구가강배혹태망배대관구엄중골결손18례19관진행중건.남8례,녀10례;년령33～76세,평균64.7세.전관관절치환술후관구주위골용해도치관구가체송동이행번수술17례,관구발육불량행관구절골술후계발관관절골관절염행전관관절치환1례.PaproskyⅡB형골결손5관,PaproskyⅡC형2관,PaproskyⅢA형6관,PaproskyⅢB형6관.결과 전부병례수방3.6～12.3년,평균6.5년.Harris관관절평분유술전평균(38.7±9.6)분제고지말차수방(87.6±7.8)분.술후3～6개월X선검사가견관구식골구골장입,1년후식골구골정합량호.수방기간미발현관구재송동병례.1례출현관구취을희명현마손,관관절선전중심상이.결론 자체골화이체냉동간조골혼합타압식골가유효회복관구골량,식골중가입적자체골가촉진식골구골장입,혼합식골방법결합관구가강배혹태망배고정치료관구엄중골결손료효학절.
Objective To investigate the role of hybrid bone grafting using autograft and freezedried allograft bone in restoration of acetabular bone defect,as well as to evaluate the clinical results of this grafting technique combined with acetabular scaffold in dealing with massive acetabular deficiency.Methods Between April 1999 to December 2007,18 patients (19 hips) underwent acetabular revision by using a mixture of autograft and allogenic freeze-dried cancellous bone particles plus acetabular scaffold.There were 8males and 10 females,aged from 33 to 76 years (average,64.7 years).The acetabular defects were caused by aseptic loosening of primary total hip arthroplasty in 17 patients and osteoarthritis secondary to osteotomy in 1 case of acetabular dysplasia.There were 5 cases of Paprosky Ⅱ B defect,2 Paprosky Ⅱ C defect,6 Paprosky ⅢA defect and 6 Paprosky ⅢB defect.Results All patients were followed up for 3.6 to 12.3 years (average,6.5 years).Harris hip score improved from preoperative 38.7±9.6 to 87.6±7.8 at final follow-up.According to X-rays,bone incorporation evidenced by trabecular bridging of the host-donor interface was found at 3to 6 months postoperatively,and effective bone incorporation was achieved in all cases one year postoperatively.Polyethylene wear occurred in one case.Acetabular component loosening was not found at final follow up.Conclusion Impacted bone grafting using a mixture of autograft and freeze-dried allograft bone can efficiently restore acetabular bone defect.Adding autograft bone to freeze-dried allograft bone is a highly effective way of achieving graft incorporation.Hybrid bone grafting technique with acetabulum scaffold is an attractive option for the treatment of extensive acetabular deficiency.