Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2011 May;124(9):1381-5.
Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.
This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky IIC, 6 were IIIA, and 4 were IIIB. The mean age at the time of surgery was 63.0 years (range, 46 - 78 years). During revision surgery, a reinforcement ring was implanted in 6 patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9 - 71 months).
The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit. The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes, debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification, aseptic loosening, or infection.
Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.
严重的髋臼骨缺损是髋臼翻修手术中的主要挑战。大多数情况下需要进行骨移植和强化装置来重建髋臼。本研究旨在评估在髋臼翻修手术中，针对严重髋臼骨缺损采用强化装置（环或笼）和骨移植进行重建的效果。
本研究纳入了 2003 年 2 月至 2008 年 10 月期间，12 例（2 例男性，10 例女性）接受强化装置（环或笼）植入和骨移植的严重髋臼骨缺损患者。采用 Paprosky 分类法，2 例为 Paprosky IIIC 型，6 例为 IIIA 型，4 例为 IIIB 型。手术时的平均年龄为 63.0 岁（46-78 岁）。在翻修手术中，6 例患者植入强化环，6 例患者植入笼。回顾性评估临床和影像学结果。平均随访时间为 37 个月（9-71 个月）。
平均 Harris 髋关节评分从术前的 35.2 分提高到最终随访时的 82.9 分。结果为优 8 髋（66.7%），良 2 髋（16.7%），可 2 髋（16.7%）。发现 1 例骨溶解，但未加重。3 例患者出现黄色伤口渗出，经换药、清创和抗生素治疗后愈合。1 例 62 岁女性患者发生脱位。行闭合复位，未再复发。无术中髋臼骨折、神经损伤、异位骨化、无菌性松动或感染证据。
对于髋臼翻修手术中的髋臼骨缺损，采用强化装置和骨移植进行重建是一种有效的治疗方法，前提是选择合适的适应证和技术。
