中国修复重建外科杂志

中国修复重建外科杂志

采用金属重建杯行髋关节翻修术的临床疗效

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目的 探讨采用金属重建杯行髋关节翻修术的临床疗效。 方法 回顾分析 2006 年 10 月—2013 年 10 月,采用金属重建杯行髋关节翻修术的 16 例(16 髋)患者临床资料。男 4 例,女 12 例;年龄 49~78 岁,平均 62.7 岁。初次人工全髋关节置换术至该次翻修术时间为 3~15 年,中位时间 8.2 年。翻修原因:假体无菌性松动 15 例,Vancouver B3 型股骨柄假体周围骨折 1 例。髋臼侧骨缺损根据美国骨科医师协会(AAOS)分型:Ⅲ型 12 例,Ⅳ型 4 例;Paprosky 分型:ⅢA 型 12 例,ⅢB 型 4 例。采用 Harris 评分评价髋关节功能,疼痛视觉模拟评分(VAS)评价术后大腿疼痛情况;摄 X 线片行影像学评价。 结果 术后患者切口均Ⅰ期愈合;1 例于术后 2 周发生下肢深静脉血栓形成,行抗凝治疗后治愈;无感染、神经血管损伤及脱位等并发症发生。16 例均获随访,随访时间 2~9 年,平均 6.8 年。末次随访时 Harris 评分为(91.88±3.28)分,较术前(42.44±4.66)分显著改善(t=–106.30,P=0.00)。2 例术后下地行走时出现轻度大腿痛,症状于术后 1 年消失。术后即刻髋臼外展角为 37~54°,平均 42.9°;髋关节旋转中心距泪滴间线距离和距泪滴外侧距离分别由术前的(33.67±12.19)mm 和(34.98±12.30)mm 改善至术后即刻的(20.67±9.63)mm 和(40.04±6.61)mm,比较差异均有统计学意义(t=–9.60,P=0.00;t=–3.15,P=0.00)。术后 4~12 个月 X 线片示所有股骨大转子延长截骨区均获骨性愈合,随访期间金属重建杯与骨面均无连续性透亮带,无假体移位及骨溶解,臼杯均呈骨性固定;无 1 例因假体松动需行再翻修手术者。 结论 对于臼杯假体松动合并髋臼骨缺损者,采用金属重建杯行翻修术可获得较好疗效。

Objective To explore the clinical outcomes of acetabular revision using a metal reconstruction cage. Methods Between October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. Conclusion The metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.

关键词: 人工全髋关节置换术; 髋臼; 翻修术; 金属重建杯

Key words: Total hip arthroplasty; acetabulum; revision; metal reconstruction cage

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