Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Biomed Res Int. 2018 Feb 4;2018:2364269. doi: 10.1155/2018/2364269. eCollection 2018.
Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.
使用颗粒化和结构性同种异体移植物来恢复翻修全髋关节置换术（THA）中大量髋臼骨缺损的骨量是一种很有吸引力的方法。然而，对于同种异体移植物吸收后能否长期稳定仍存在担忧。2003 年至 2012 年，回顾性分析了 58 例患者 59 髋接受翻修 THA 治疗 Paprosky Ⅱ或Ⅲ型髋臼缺损的病例。髋臼缺损采用深冻颗粒化和结构性同种异体移植物以及压配式非骨水泥杯和补充螺钉进行处理。平均随访 8.7 年，分析临床和影像学结果。对于 Paprosky Ⅱ型缺损的髋关节，临床成功率为 100%；对于 ⅢA 型缺损，成功率为 95.2%；对于 ⅢB 型缺损，成功率为 92.8%。3 例 Ⅲ型缺损的髋关节分别在 4、7 和 9 年后失败。Harris 髋关节评分从术前的 60.1 分显著提高到末次随访时的 91.3 分。所有临床效果良好的髋关节在同种异体骨-宿主骨界面均出现了骨小梁桥接。深冻结构性和颗粒化同种异体移植物联合压配式非骨水泥杯是翻修 THA 中重建髋臼缺损的一种可行选择。
