Fryhofer George W, Ramesh Sireesh, Sheth Neil P
Orthopaedic Surgery Resident, University of Pennsylvania, Department of Orthopaedic Surgery, 3737 Market Street, Philadelphia, PA, 19104, USA.
University of Pennsylvania, The Wharton School, College of Arts & Sciences, 3730 Walnut Street, Philadelphia, PA, 19104, USA.
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):22-28. doi: 10.1016/j.jcot.2019.11.004. Epub 2019 Dec 2.
The number of total hip arthroplasty (THA) procedures performed annually continues to rise. Specific challenges, including acetabular bone loss, are commonly encountered at the time of revision surgery, and orthopaedic surgeons must be prepared to address them. This review focuses on topics related to acetabular reconstruction, including pre-operative patient evaluation (clinical and radiographic), pre-operative planning, common causes of acetabular failure, classification of acetabular bone loss, methods of acetabular reconstruction, and clinical results based on reconstruction method. Pre-operative patient evaluation for revision THA begins with a thorough history and physical examination as well as laboratory workup to rule out infection. Detailed radiographic evaluation and pre-operative planning are also essential and will facilitate communication amongst all members of the operative team. Although there are several ways to describe acetabular bone loss, the Paprosky classification system - defined by anterosuperior and posteroinferior acetabular column integrity - is the system most commonly used today and will guide treatment strategy. Several treatment strategies have been developed and may be termed either "cemented" (e.g. impaction grafting, ring and cage construction, structural allograft) or "uncemented" (e.g. hemispheric shell ± porous metal augment, cup-cage, custom triflange acetabular component). Although each strategy has its advantages and disadvantages, the general principles remain the same. Successful treatment depends upon detailed pre-operative assessment, planning, and team-based plan execution. Uncemented techniques that allow for biologic fixation are preferred. In the special case of pelvic discontinuity, acetabular distraction is the authors' preferred technique. Longer term studies are still needed to evaluate the longevity of each of the various reconstruction methods presented.
每年进行的全髋关节置换术（THA）手术数量持续上升。在翻修手术时，常会遇到包括髋臼骨丢失在内的特定挑战，骨科医生必须做好应对这些挑战的准备。本综述聚焦于与髋臼重建相关的主题，包括术前患者评估（临床和影像学）、术前规划、髋臼失败的常见原因、髋臼骨丢失的分类、髋臼重建方法以及基于重建方法的临床结果。翻修THA的术前患者评估始于全面的病史采集、体格检查以及实验室检查以排除感染。详细的影像学评估和术前规划也至关重要，这将促进手术团队所有成员之间的沟通。虽然有几种描述髋臼骨丢失的方法，但帕罗斯基分类系统——由髋臼前上柱和后下柱的完整性定义——是目前最常用的系统，它将指导治疗策略。已经开发了几种治疗策略，可分为“骨水泥型”（例如打压植骨、环和笼构建、结构性同种异体骨移植）或“非骨水泥型”（例如半球形髋臼杯±多孔金属增强物、髋臼杯-笼、定制三叶髋臼组件）。虽然每种策略都有其优缺点，但一般原则是相同的。成功的治疗取决于详细的术前评估、规划以及基于团队的计划执行。允许生物固定的非骨水泥技术是首选。在骨盆连续性中断的特殊情况下，髋臼牵张是作者首选的技术。仍需要进行长期研究以评估所介绍的各种重建方法的长期效果。
