Gehrke Thorsten, Bangert Yannic, Schwantes Bernd, Gebauer Matthias, Kendoff Daniel
HELIOS ENDO-Klinik Hamburg, Hamburg - Germany.
Hip Int. 2013 Jul-Aug;23(4):359-65. doi: 10.5301/hipint.5000044. Epub 2013 Jun 17.
Acetabular revision with associated bone loss in uncontained defects can be difficult. We report preliminary results utilising a novel technique, combining tantalum-augments with allograft bone and cemented cups.
Forty-six patients undergoing cup revision with a tantalum augment and allografting were clinically (HHS) and radiographically reviewed at an average of 46 months postoperatively. There were 28 type-2B and 18 type-3A Paprosky defects. Postoperative images were assessed for osteointegration, bone-remodelling and recreation of the native hip centre.
The average patient age at time of acetabular revision was 65 years, with 18 male and 28 female patients. The HHS improved on average from 44 to 82 points. Correction of the high hip centre was possible in all patients with average medialisation of 10 mm and lowering of the hip centre by 14 mm. Four patients (four hips) sustained a hip dislocation postoperatively and one required revision. Two acetabular revisions were necessary after implantation, because of early cup loosening and failure of the construct. In one of these, the tantalum augment was found to be well fixed. Of the remaining hips, at latest radiographic follow-up, 44 tantalum implants were radiographically stable and osteointegrated. Non-progressive radiolucent lines were present around the acetabular component in two other hips.
The combination of tantalum-augmentation with impaction allografting is a promising technique to manage severe uncontained acetabular defects.
对于髋臼翻修术中伴有髋臼骨缺损且缺损范围较大的情况，手术难度较大。我们报告了一项新技术的初步结果，该技术将钽增强物与同种异体骨和骨水泥杯相结合。
对46例行钽增强物和同种异体骨移植髋臼翻修术的患者进行了临床（Harris髋关节评分，HHS）和影像学评估，平均随访时间为术后46个月。其中有28例Paprosky 2B型和18例3A型骨缺损。对术后影像进行评估，观察骨整合、骨重塑以及髋关节中心的恢复情况。
髋臼翻修时患者的平均年龄为65岁，男性18例，女性28例。HHS评分平均从44分提高到82分。所有患者均实现了高位髋关节中心的矫正，平均向内侧移位10 mm，髋关节中心下降14 mm。4例（4髋）患者术后发生髋关节脱位，其中1例需要再次翻修。植入后有2例髋臼需要再次翻修，原因是髋臼杯早期松动和结构失败。其中1例中，钽增强物固定良好。在其余髋关节中，在最近一次影像学随访时，44枚钽植入物在影像学上稳定且已骨整合。另外2例髋臼假体周围出现了无进展的透亮线。
钽增强物与打压植骨相结合是治疗严重髋臼骨缺损的一种有前景的技术。
