中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
6期
419-423
,共5页
王北岳%周利武%张志强%郭亭%赵建宁
王北嶽%週利武%張誌彊%郭亭%趙建寧
왕북악%주리무%장지강%곽정%조건저
髋关节%关节成形术,置换,髋%人工关节%髋臼
髖關節%關節成形術,置換,髖%人工關節%髖臼
관관절%관절성형술,치환,관%인공관절%관구
Hip joint%Arthroplasty,replacement,hip%Joint prosthesis%Acetabulum
目的：探讨大臼杯在PaproskyII型及PaproskyIIIA型全髋关节置换术后髋臼骨缺损翻修中的应用。方法回顾性分析了2007年3月至2014年5月，经治的24例PaproskyII型及PaproskyIIIA型全髋关节置换术后髋臼骨缺损病例。其中男13例，女11例，平均年龄61.46(34～77)岁。髋臼侧行翻修的原因：无菌性松动21例，髋关节习惯性脱位2例，低毒性感染1例。所有手术均为初次单侧翻修，初次关节置换髋臼侧：11例为骨水泥固定的髋臼假体，10例为非骨水泥型髋假体，3例为人工股骨头置换。髋臼骨缺损按Paprosky分型法：II A型7髋，II B型6髋，II C型5髋，III A型6髋。采用大臼杯或联合植骨对髋臼假体进行翻修，对于Paprosky II 型骨缺损在不影响假体稳定性的情况下通过挫磨扩大髋臼，植入颗粒骨或直接置入大臼杯髋臼假体。Paprosky III A 型骨缺损，采用适量植入打压颗粒植骨，或结构性植骨、臼底骨块封堵技术以提高骨量，或直接采用高位球中心植入技术，配合大臼杯植入，而双下肢平衡及偏心距均通过假体柄及颈的长度来调节。术后定期随访，采用Harris方法及VAS评分评估髋关节功能及状态，根据X线片判断假体稳定性及植骨愈合情况。结果24例平均随访23.84(12～83)个月，Harris髋关节评分：术前(44.92±10.53)分，术后12个月(84.75±4.61)分( P＜0.01)，术后3年(88.88±5.70)分( P＜0.01)。VAS评分：术前(4.58±1.69)分，术后12个月(0.71±0.91)分( P＜0.01)，术后3年(0.50±0.66)分( P＜0.01)。未出现假体修复失败而需要再次翻修病例。X 线片显示移植骨与宿主骨交界处有连续性骨小梁通过。患者下地行走步态良好，随访期间无假体脱位、松动及髋关节异常疼痛影响行走，术后1年患髋屈曲均能至少达90°，术后3年均能满足日常生活需要并能慢跑、下蹲持物。结论在PaproskyII型及PaproskyIIIA型髋臼骨缺损翻修术中，采用大臼杯或联合颗粒/结构植骨，可以取得良好效果。假体的合理选择及适当的髋臼骨缺损的处理，可以降低髋臼侧翻修手术难度并取得优良效果。
目的：探討大臼杯在PaproskyII型及PaproskyIIIA型全髖關節置換術後髖臼骨缺損翻脩中的應用。方法迴顧性分析瞭2007年3月至2014年5月，經治的24例PaproskyII型及PaproskyIIIA型全髖關節置換術後髖臼骨缺損病例。其中男13例，女11例，平均年齡61.46(34～77)歲。髖臼側行翻脩的原因：無菌性鬆動21例，髖關節習慣性脫位2例，低毒性感染1例。所有手術均為初次單側翻脩，初次關節置換髖臼側：11例為骨水泥固定的髖臼假體，10例為非骨水泥型髖假體，3例為人工股骨頭置換。髖臼骨缺損按Paprosky分型法：II A型7髖，II B型6髖，II C型5髖，III A型6髖。採用大臼杯或聯閤植骨對髖臼假體進行翻脩，對于Paprosky II 型骨缺損在不影響假體穩定性的情況下通過挫磨擴大髖臼，植入顆粒骨或直接置入大臼杯髖臼假體。Paprosky III A 型骨缺損，採用適量植入打壓顆粒植骨，或結構性植骨、臼底骨塊封堵技術以提高骨量，或直接採用高位毬中心植入技術，配閤大臼杯植入，而雙下肢平衡及偏心距均通過假體柄及頸的長度來調節。術後定期隨訪，採用Harris方法及VAS評分評估髖關節功能及狀態，根據X線片判斷假體穩定性及植骨愈閤情況。結果24例平均隨訪23.84(12～83)箇月，Harris髖關節評分：術前(44.92±10.53)分，術後12箇月(84.75±4.61)分( P＜0.01)，術後3年(88.88±5.70)分( P＜0.01)。VAS評分：術前(4.58±1.69)分，術後12箇月(0.71±0.91)分( P＜0.01)，術後3年(0.50±0.66)分( P＜0.01)。未齣現假體脩複失敗而需要再次翻脩病例。X 線片顯示移植骨與宿主骨交界處有連續性骨小樑通過。患者下地行走步態良好，隨訪期間無假體脫位、鬆動及髖關節異常疼痛影響行走，術後1年患髖屈麯均能至少達90°，術後3年均能滿足日常生活需要併能慢跑、下蹲持物。結論在PaproskyII型及PaproskyIIIA型髖臼骨缺損翻脩術中，採用大臼杯或聯閤顆粒/結構植骨，可以取得良好效果。假體的閤理選擇及適噹的髖臼骨缺損的處理，可以降低髖臼側翻脩手術難度併取得優良效果。
목적：탐토대구배재PaproskyII형급PaproskyIIIA형전관관절치환술후관구골결손번수중적응용。방법회고성분석료2007년3월지2014년5월，경치적24례PaproskyII형급PaproskyIIIA형전관관절치환술후관구골결손병례。기중남13례，녀11례，평균년령61.46(34～77)세。관구측행번수적원인：무균성송동21례，관관절습관성탈위2례，저독성감염1례。소유수술균위초차단측번수，초차관절치환관구측：11례위골수니고정적관구가체，10례위비골수니형관가체，3례위인공고골두치환。관구골결손안Paprosky분형법：II A형7관，II B형6관，II C형5관，III A형6관。채용대구배혹연합식골대관구가체진행번수，대우Paprosky II 형골결손재불영향가체은정성적정황하통과좌마확대관구，식입과립골혹직접치입대구배관구가체。Paprosky III A 형골결손，채용괄량식입타압과립식골，혹결구성식골、구저골괴봉도기술이제고골량，혹직접채용고위구중심식입기술，배합대구배식입，이쌍하지평형급편심거균통과가체병급경적장도래조절。술후정기수방，채용Harris방법급VAS평분평고관관절공능급상태，근거X선편판단가체은정성급식골유합정황。결과24례평균수방23.84(12～83)개월，Harris관관절평분：술전(44.92±10.53)분，술후12개월(84.75±4.61)분( P＜0.01)，술후3년(88.88±5.70)분( P＜0.01)。VAS평분：술전(4.58±1.69)분，술후12개월(0.71±0.91)분( P＜0.01)，술후3년(0.50±0.66)분( P＜0.01)。미출현가체수복실패이수요재차번수병례。X 선편현시이식골여숙주골교계처유련속성골소량통과。환자하지행주보태량호，수방기간무가체탈위、송동급관관절이상동통영향행주，술후1년환관굴곡균능지소체90°，술후3년균능만족일상생활수요병능만포、하준지물。결론재PaproskyII형급PaproskyIIIA형관구골결손번수술중，채용대구배혹연합과립/결구식골，가이취득량호효과。가체적합리선택급괄당적관구골결손적처리，가이강저관구측번수수술난도병취득우량효과。
Objective To investigate the application of jumbo acetabular cups for Paprosky type II and type III A acetabular deifciencies after total hip arthroplasty ( THA ).Methods The clinical data of 24 patients who were diagnosed as acetabular deifciencies of Paprosky type II or type III A after THA from March 2007 to May 2014 were retrospectively analyzed. There were 13 males and 11 females, whose average age was 61.46 years old ( range: 34-77 years ). As to the reason of acetabular revision, there were 21 cases caused by aseptic loosening, 2 cases by habitual hip dislocation and 1 case by low toxicity infection. Primary and unilateral revision was performed on all the patients. Cemented acetabular prostheses were used in 11 cases, cementless acetabular prostheses in 10 cases and artiifcaial femoral head arthrolasty in 3 cases. According to the Paprosky acetabular defect classiifcation, there were 7 hips of type II A, 6 hips of type II B, 5 hips of type II C and 6 hips of type III A. Jumbo acetabular cups or combined with bone grafts were used in acetabular revision with prostheses. For the patients with acetabular deifciencies of Paprosky type II, the acetabulum was reamed and enlarged on the premise that the stability of the prosthesis was not affected, and then morselized bone graft was performed or the acetabular prosthesis with a jumbo cup was directly put in. For the patients with acetabular deifciencies of Paprosky type III A, an appropriate amount of compacted and morselized bone graft was used. Structural bone graft or the acetabular notch sealing was carried out, so as to increase the bone mass. The implantation technique through the center of the high ball could be directly adopted, with jumbo acetabular cups embedded. The problems of the balance of both lower limbs and the eccentricity could be handled by adjusting the length of the prosthetic handle and neck. A regular follow-up was carried out after the operation. The Harris hip score and Visual Analogue Scale ( VAS ) score were used to evaluate the hip function and state. The prosthetic stability and bone union were judged based on the X-ray.Results All the patients were followed up for a mean period of 23.84 months ( range: 12-83 months ) to evaluate the hip function and the pain problem. The Harris hip scores were ( 44.92±10.53 ) points, ( 84.75±4.61 ) points and ( 88.88±5.70 ) points preoperatively and at 1 and 3 years after the operation (P<0.01 ). The VAS scores were ( 4.58±1.69 ) points, ( 0.71±0.91 ) points and ( 0.50±0.66 ) points preoperatively and at 1 and 3 years after the operation (P<0.01 ). No patient required a second revision because of the failure of prosthetic revision. The X-ray showed strong evidence of trabecular bridging between the bone graft and the host bone. The gait of the patients recovered to normal, and their walking was not affected by prosthetic dislocation or loosening or abnormal hip pain during the follow-up. At 1 year after the operation, the hip lfexion angel reached to more than 90°. And at 3 years after the operation, the patients could complete daily activities, and even jog or squat. Conclusions Jumbo acetabular cups or combined with morselized or structural bone graft are effective for Paprosky type II and type III A acetabular deifciencies after THA. The dififculty in acetabular revision can be reduced and the results are excellent, with reasonable selection of the prostheses and suitable management of acetabular deifciencies.
