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小梁金属增强物用于重建Paprosky Ⅲ型髋臼骨缺损的效果

[Effects of trabecular metal augments for the reconstruction of Paprosky type Ⅲ acetabulum bone defects].

作者信息

Du Y Q, Zhou Y G, Piao S, Wu W M, Ma H Y, Gao Z S, Sun J Y, Zheng C, Wang S

机构信息

Department of Orthopedics Surgery, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2017 Jun 1;55(6):410-415. doi: 10.3760/cma.j.issn.0529-5815.2017.06.003.

Abstract

To investigate the methods and short-time clinical results of reconstruction of Paprosky type Ⅲ acetabulum bone defects by using tantalum augments. A total of 17 patients (17 hips) with Paprosky type Ⅲ acetabulum bone defects, treated with tantalum augments in revision of total hip arthroplasty at Department of Orthopedics Surgery in General Hospital of Chinese People's Liberation Army were retrospectively analyzed from March 2014 to May 2016.There were 6 males and 11 females aged from 23 to 74 years with an average of (50.2±16.3) years. Tantalum augments or TM-Cup augment (the cup-on-cup technique) were used to reconstruct the defects.The TM-Cup augment was the tantalum revision cup which was removed titanium ring. The cup-on-cup technique combined TM-Cup augment and biological acetabulum cup. Augments were served as the nonresorptive structural allograft in revision of total hip arthroplasty. Harris hip score was used to evaluate clinical effects. The vertical position of the rotation center was measured and analyzed. Radiographic assessments of the acetabular components were performed by DeLee-Charnley and the Anderson criteria and recorded postoperative complications. All the patients were followed up from 3 to 29 months with an average of (16.2±5.4) months, tantalum augments and biological acetabulum cup were used in 13 patients, the TM-Cup augment and biological acetabulum cup were used in 4 patients. At the time of the latest follow-up, the mean Harris hip score increased compared to preoperatively (86.8±8.3 . 30.0±12.0) (=12.78, <0.01), the average vertical location of the center of rotation was decreased ((25.3±9.8) mm .(47.6±10.5)) mm (=4.95, <0.01). All the tantalum augments and biological acetabulum cups were stable, there were no infection, dislocation and other complications. The use of tantalum augments could be considered as an effective management of Paprosky type Ⅲ defects providing good clinical and radiographic outcomes in the short term.The cup-on-cup technique which was used in reconstruction of severe superior-invagination acetabular bone defects and restoration relatively normal center of rotation had special application value.

摘要

探讨使用钽增强物重建PaproskyⅢ型髋臼骨缺损的方法及短期临床效果。回顾性分析2014年3月至2016年5月在中国人民解放军总医院骨科行全髋关节置换翻修术时采用钽增强物治疗的17例(17髋)PaproskyⅢ型髋臼骨缺损患者。其中男6例,女11例,年龄23~74岁,平均(50.2±16.3)岁。采用钽增强物或TM-Cup增强物(杯上加杯技术)重建缺损。TM-Cup增强物为去除钛环的钽翻修杯。杯上加杯技术将TM-Cup增强物与生物髋臼杯相结合。增强物在全髋关节置换翻修术中作为不可吸收的结构性同种异体移植物。采用Harris髋关节评分评估临床效果。测量并分析旋转中心的垂直位置。采用DeLee-Charnley和Anderson标准对髋臼假体进行影像学评估,并记录术后并发症。所有患者均随访3~29个月,平均(16.2±5.4)个月,13例患者采用钽增强物和生物髋臼杯,4例患者采用TM-Cup增强物和生物髋臼杯。末次随访时,Harris髋关节评分均值较术前升高(86.8±8.3比30.0±12.0,t=12.78,P<0.01),旋转中心平均垂直位置降低((25.3±9.8)mm比(47.6±10.5)mm,t=4.95,P<0.01)。所有钽增强物和生物髋臼杯均稳定,无感染、脱位等并发症。使用钽增强物可被认为是治疗PaproskyⅢ型缺损的有效方法,在短期内可提供良好的临床和影像学结果。杯上加杯技术在严重上陷型髋臼骨缺损的重建及恢复相对正常的旋转中心方面具有特殊应用价值。

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