反复多次定制髋臼假体成形术治疗严重髋臼骨缺损患者的结果：病例系列研究。

Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series.

机构信息

Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.

Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.

出版信息

Hip Int. 2020 Sep;30(1_suppl):64-71. doi: 10.1177/1120700020928247.

DOI:10.1177/1120700020928247

PMID:32907426

Abstract

BACKGROUND

Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a "second" rTHA with "custom-made acetabular components (CMACs)" after a previously failed reconstruction with CMACs.

METHODS

4 patients with severe acetabular bone loss (Paprosky Type IIIB), who required a second rTHA after a previously failed reconstruction with CMAC, due to prosthetic joint infection (PJI), were included in our retrospective study. All prostheses had been constructed on the basis of thin-layer computed-tomography scans of the pelvis. The second rTHA was considered unsuccessful in the event of PJI or aseptic loosening (AL) with need for renewed CMAC explantation.

RESULTS

The treatment success rate after second rTHA with a CMAC was 50% (2 of 4). In the successful cases, the visual analogue scale (VAS) score and Harris Hip Score (HHS) after the second rTHA (VAS range 2-4; HHS range 45-58 points) did not differ from those after the first rTHA, before onset of symptoms (VAS: range 2-4; HHS: range 47-55 points). In the failed cases, the second CMACs needed to be explanted due to PJI, with renewed detection of previous pathogens. Patients with treatment failure of the second CMAC had required a higher number of revision surgeries after explantation of the first CMAC than patients with a successful outcome.

CONCLUSIONS

In patients with severe acetabular bone loss and previously failed rTHA with CMACs, repeat rTHA with a CMAC may be a solid treatment option for patients with an "uncomplicated" multi-stage procedure, i.e., without persisting infection after explantation of the original CMAC. While the outcome in terms of clinical function does not appear negatively affected by such a "second attempt," the complication rate and risk of reinfection, nonetheless, is high.

摘要

背景

在翻修全髋关节置换术（rTHA）中，对于严重髋臼骨缺损（伴或不伴骨盆连续性中断）的病例，重建失败仍然是骨科的一大挑战。本研究旨在描述在先前使用定制髋臼组件（CMAC）重建失败后，再次使用“定制髋臼组件（CMAC）”进行“二次”rTHA 的结果。

方法

本回顾性研究纳入了 4 例因假体关节感染（PJI）而需要再次进行 rTHA 的严重髋臼骨缺损（Paprosky Ⅲ B 型）患者，这些患者先前使用 CMAC 进行重建失败。所有假体均基于骨盆薄层计算机断层扫描（CT）构建。如果发生 PJI 或无菌性松动（AL），需要重新取出 CMAC，则认为第二次 rTHA 不成功。

结果

第二次使用 CMAC 进行 rTHA 的治疗成功率为 50%（4 例中有 2 例）。在成功的病例中，第二次 rTHA 后的视觉模拟评分（VAS）和髋关节 Harris 评分（HHS）（VAS 范围 2-4；HHS 范围 45-58 分）与症状出现前第一次 rTHA 后（VAS：范围 2-4；HHS：范围 47-55 分）无差异。在失败的病例中，由于 PJI 导致第二次 CMAC 需要取出，且先前的病原体再次被检测到。与第二次 CMAC 成功的患者相比，第二次 CMAC 失败的患者在取出第一次 CMAC 后需要进行更多次的翻修手术。

结论

对于严重髋臼骨缺损和先前使用 CMAC 进行 rTHA 失败的患者，在没有在取出原始 CMAC 后持续感染的情况下，对“单纯”多阶段手术（即无感染）的患者，再次使用 CMAC 进行 rTHA 可能是一种可靠的治疗选择。虽然这种“二次尝试”在临床功能方面的结果似乎没有受到负面影响，但并发症发生率和再感染风险仍然很高。