[采用嵌压式辐照冷冻同种异体骨进行髋臼翻修术]

Wang Qi, Zhang Xian-Long, Jiang Yao, Chen Yun-Su, Shen Hao, Shao Jun-Jie

Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.

Zhonghua Wai Ke Za Zhi. 2010 Jul 15;48(14):1045-9.

OBJECTIVE

To analyze the clinical and radiographical result of acetabular revisions with wire mesh, impacted irradiated frozen allografts and cemented cups.

METHODS

From February 2006 to January 2009, a total of 20 patients with 21 acetabular revisions were performed with wire mesh, impacted irradiated frozen allografts and cemented cups. Eighteen cases (19 hips) were followed up. There were 5 hips in 4 males and 14 hips in 14 females. The average age of patients was 64.4 years (43 to 81 years). Acetabular bone defects were classified according to Paprosky classification. There were Paprosky II B in 4 hips, Paprosky II C in 8 hips, Paprosky IIIA in 5 hips and Paprosky IIIB in 2 hips. Wire mesh was used to converted segmental defects into cavity defects. Irradiated frozen allografts were impacted and cemented cup was inserted to complete the revision. Patients were followed up regularly with clinical and radiographical assessment. Harris score, migration and loosening of prosthesis grafts integration and complications were observed.

RESULTS

The average follow-up time was 22.4 months (12 - 48 months). Harris score improved from 42.5 points (31 - 56 points) pre-operation to 88.6 points (82 - 96 points) at the final follow up. Pain score was 14.4 point (10 - 20 point) before revision and 42.3 points (40 - 44 point) at the final follow up.

COMPLICATIONS

there was 1 infection and healing after debridement. One patient had weakness of quadriceps and returned to normal after 1 year. Greater trochanter fracture occurred in 1 patient. Cup migration and loosening were observed in 1 Paprosky IIIB patients. There was no cup migration more than 1 mm or change of abduction angle in the remaining 18 hips. Grafts incorporation defined as the presence of trabecular bone crossing the graft-host bond could also be seen in these 18 hips.

CONCLUSIONS

Impacted bone grafting technique combined with wire mesh and cemented cup is an effective method for biological acetabular revision. Irradiated frozen allografts implanted with impaction bone grafting technique can integrate with the surrounding host bone.

目的

分析使用金属网、打压植入辐照冷冻异体骨及骨水泥杯进行髋臼翻修术的临床及影像学结果。

方法

2006年2月至2009年1月，共20例患者接受了21次髋臼翻修术，采用金属网、打压植入辐照冷冻异体骨及骨水泥杯。对18例（19髋）进行了随访。其中男性4例5髋，女性14例14髋。患者平均年龄64.4岁（43至81岁）。髋臼骨缺损按Paprosky分类法进行分类。Paprosky II B型4髋，Paprosky II C型8髋，Paprosky III A型5髋，Paprosky III B型2髋。使用金属网将节段性缺损转化为腔隙性缺损。打压植入辐照冷冻异体骨并植入骨水泥杯以完成翻修。对患者进行定期临床及影像学评估。观察Harris评分、假体移位、移植骨与假体的整合情况及松动情况以及并发症。