Yang Bo, Lin Jin, Weng Xi-Sheng, Jin Jin, Zhao Qing, Qiu Gui-Xing
Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Wai Ke Za Zhi. 2009 Jun 15;47(12):920-3.
To discuss the characteristics and reconstruction strategies of acetabular bone deficiency in total hip arthroplasty in order to find the optimal resolution for this clinical puzzle.
Clinical and radiological materials of 37 patients (37 hips) with acetabular deficiency who underwent primary or revision total hip arthroplasty were analyzed retrospectively from May 1998 to August 2008. According to the common classification system for acetabular bone deficiency-the AAOS classification system, the acetabular bone defect was reconstructed using morselized or structural bone grafting, accessory acetabular hardware (ring, cup or cage) together with cemented or cementless acetabular component respectively. All patients were followed up regularly to assess their hip function improvement by measuring the Harris hip score and to find out the grafting bone healing, absorption and position of the prosthesis by plain radiographic examination.
There were 11 primary and 26 revision total hip arthroplasty. There were 9 hips of AAOS-type I defect, 13 of type II and 15 of type III. Morselized bone grafting was used in 24 cases, bulk structural bone grafting in 6 cases and mixed bone grafting in 7 cases. Twenty-one patients used cementless prosthesis and 16 used cemented prosthesis. The average follow-up period was 53.7 months (6.5 to 130.5 months), the average preoperative Harris hip score was 42 +/- 8 with contrast to 87 +/- 5 of post-operation. Statistically significant difference was found according to t-test with P value less than 0.05. Major or complete healing of grafting bone was obtained at the latest follow-up.
Acetabular bone defect during primary or revision total hip arthroplasty should be reconstructed according to its characteristics and severity. For relatively simple AAOS type I and type II cases, morselized or bulk structural bone grafting together with cementless prosthesis could achieve favorable initial stability, but for more severe AAOS type III cases, bulk structural bone grafting with accessory reinforcement hardware would be necessary. Though the early and mid-term results of the above strategies are satisfied, the long term outcome still require further study.
探讨全髋关节置换术中髋臼骨缺损的特点及重建策略，以寻找解决这一临床难题的最佳方案。
回顾性分析1998年5月至2008年8月期间37例（37髋）髋臼缺损患者接受初次或翻修全髋关节置换术的临床及影像学资料。根据髋臼骨缺损的常用分类系统——美国矫形外科医师学会（AAOS）分类系统，分别采用颗粒状或结构性植骨、髋臼辅助金属植入物（环、髋臼杯或髋臼笼）联合骨水泥型或非骨水泥型髋臼假体对髋臼骨缺损进行重建。所有患者均定期随访，通过测量Harris髋关节评分评估髋关节功能改善情况，并通过X线平片检查了解植骨愈合、吸收及假体位置。
初次全髋关节置换术11例，翻修手术26例。AAOS I型缺损9髋，II型13髋，III型15髋。24例采用颗粒状植骨，6例采用大块结构性植骨，7例采用混合植骨。21例患者使用非骨水泥型假体，16例使用骨水泥型假体。平均随访时间为53.7个月（6.5至130.5个月），术前Harris髋关节平均评分为42±8分，术后为87±5分。经t检验，差异有统计学意义（P值<0.05）。在最后一次随访时，植骨获得主要或完全愈合。
初次或翻修全髋关节置换术中的髋臼骨缺损应根据其特点和严重程度进行重建。对于相对简单的AAOS I型和II型病例，颗粒状或大块结构性植骨联合非骨水泥型假体可获得良好的初始稳定性，但对于更严重的AAOS III型病例，则需要大块结构性植骨并辅以增强金属植入物。尽管上述策略的早期和中期结果令人满意，但长期疗效仍需进一步研究。
