Chen Leilei, Hong Guoju, Lin Tianye, Huang Linfeng, Zhang Qingwen, He Wei
Third Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China.
The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;The First Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;Devision of Orthopeadic Surgery, the University of Alberta, Canada.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Mar 15;34(3):341-346. doi: 10.7507/1002-1892.201904153.
To investigate the short- and mid-term effectiveness of revision hip arthroplasty by using impaction bone allograft and acetabular components in treatment of severe acetabular defects.
A clinical data of 42 patients (44 hips) with severe acetabular defects between February 2011 and May 2018 were retrospectively analyzed. All patients underwent revision hip arthroplasty by using impaction bone allograft and acetabular components. Cemented cup (24 cases, 24 hips) and non-cemented cup (18 cases, 20 hips) were used in the revision surgery. There were 17 males and 25 females with an average age of 62.8 years (range, 22-84 years). The interval between the first total hip arthroplasty and revision was 2.5-12.0 years (mean, 8.3 years). The patients were accepted revision surgery for prosthesis aseptic loosening in 32 hips (31 cases) and the periprosthetic infection in 12 hips (11 cases). Twenty-nine hips (28 cases) were Paprosky type ⅢA and 15 hips (14 cases) were type ⅢB. The preoperative Harris score was 22.25±10.31 and the height of hip rotation center was (3.67±0.63) cm and the length difference of lower limbs was (3.41±0.64) cm.
The operation time was 130-245 minutes (mean, 186 minutes) and the intraoperative blood loss was 600-2 400 mL (mean, 840 mL). The postoperative drainage volume was 250-1 450 mL (mean, 556 mL). Superficial infection of the incision occurred in 1 case, and the incisions healed by first intention in the other patients. All patients were followed up 6-87 months, with an average of 48.6 months. At last follow-up, the Harris score was 85.85±9.31, which was significantly different from the preoperative score ( =18.563, =0.000). Imaging examination revealed that the allogeneic bone gradually fused with the host bone, and no obvious bone resorption was observed. At last follow-up, the height of the hip rotation center was (1.01±0.21) cm, which was significantly different from the preoperative level ( =17.549, =0.000); the length difference of lower limbs was (0.62±0.51) cm, which was significantly different from the preoperative level ( =14.211, =0.000). The Harris score in the cemented group and non-cemented group increased significantly at last follow-up. The height of the hip rotation center decreased, and the hip rotation centers of both groups were within the Ranawat triangle zone. The length difference of the lower limbs also decreased, and the differences in all indexes were significant between pre- and post-operation ( <0.05). There was significant difference in the height of the hip rotation center between groups ( =2.095, =0.042), but there was no significant difference in the Harris score and the length difference of lower limbs between groups ( >0.05).
For severe acetabular defect (Paprosky type Ⅲ), the hip can be reconstructed with the impaction bone allograft and cemented or non-cemented components in revision hip arthroplsty. The short- and mid-term effectiveness are satisfactory.
探讨采用打压植骨和髋臼假体翻修髋关节置换术治疗严重髋臼骨缺损的中短期疗效。
回顾性分析2011年2月至2018年5月期间42例（44髋）严重髋臼骨缺损患者的临床资料。所有患者均采用打压植骨和髋臼假体行髋关节翻修术。翻修手术中使用骨水泥型髋臼杯（24例，24髋）和非骨水泥型髋臼杯（18例，20髋）。患者中男性17例，女性25例，平均年龄62.8岁（范围22 - 84岁）。首次全髋关节置换术至翻修的间隔时间为2.5 - 12.0年（平均8.3年）。32髋（31例）因假体无菌性松动接受翻修手术，12髋（11例）因假体周围感染接受翻修手术。29髋（28例）为PaproskyⅢA型，15髋（14例）为ⅢB型。术前Harris评分为22.25±10.31，髋关节旋转中心高度为（3.67±0.63）cm，双下肢长度差为（3.41±0.64）cm。
手术时间为130 - 245分钟（平均186分钟），术中出血量为600 - 2400 mL（平均840 mL）。术后引流量为250 - 1450 mL（平均556 mL）。切口发生浅表感染1例，其余患者切口均一期愈合。所有患者均获随访6 - 87个月，平均48.6个月。末次随访时，Harris评分为85.85±9.31，与术前评分相比差异有统计学意义（t = 18.563，P = 0.000）。影像学检查显示异体骨与宿主骨逐渐融合，未观察到明显的骨吸收。末次随访时，髋关节旋转中心高度为（1.01±0.21）cm，与术前水平相比差异有统计学意义（t = 17.549，P = 0.000）；双下肢长度差为（0.62±0.51）cm，与术前水平相比差异有统计学意义（t = 14.211，P = 0.000）。末次随访时骨水泥组和非骨水泥组Harris评分均显著提高。髋关节旋转中心高度降低，两组髋关节旋转中心均位于Ranawat三角区内。双下肢长度差也减小，所有指标术前与术后比较差异均有统计学意义（P < 0.05）。两组间髋关节旋转中心高度差异有统计学意义（t = 2.095，P = 0.042），但两组间Harris评分及双下肢长度差差异无统计学意义（P > 0.05）。
对于严重髋臼骨缺损（PaproskyⅢ型），髋关节翻修术中采用打压植骨联合骨水泥型或非骨水泥型假体可重建髋关节，中短期疗效满意。
