Gross Allan E, Goodman Stuart
Division of Orthopaedic Surgery, University of Toronto, Suite 476A, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Clin Orthop Relat Res. 2004 Dec(429):193-200. doi: 10.1097/01.blo.0000149822.49890.5e.
Treating large segmental acetabular defects that comprise more than 50% of the acetabulum is one of the most difficult challenges in revision arthroplasty of the hip. One of the surgical options is a structural acetabular allograft. Unless these allografts are protected by a cage that extends from ilium to ischium, there is an unacceptable incidence of graft failure. The cage allows reconstruction at the correct anatomic level. It provides a scaffold for bone grafting (structural and morsellized). The use of cement to stabilize the cup allows the surgeon to adjust the cup position independent of the cage. The current generation of cages does not provide biologic fixation and with time may loosen or fracture. Recent experience with a combination of a trabecular metal shell protected by a cage may offer a more favorable environment for bone grafting with permanent biologic fixation of the cup cage construct.
治疗占髋臼50%以上的大面积节段性髋臼缺损是髋关节翻修术中最具挑战性的难题之一。手术选择之一是结构性髋臼同种异体骨移植。除非这些同种异体骨受到从髂骨延伸至坐骨的笼子保护，否则移植失败的发生率将令人难以接受。该笼子可在正确的解剖层面进行重建。它为骨移植（结构性和碎骨）提供了支架。使用骨水泥固定髋臼杯可使外科医生独立于笼子调整髋臼杯位置。目前一代的笼子无法提供生物固定，随着时间推移可能会松动或断裂。最近使用由笼子保护的小梁金属杯的经验，可能为骨移植提供更有利的环境，并使髋臼杯 - 笼子结构获得永久性生物固定。
