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一例翻修全髋关节置换术中需重建股骨距的非骨水泥打压植骨病例。

A Case of Cementless Impaction Bone Graft in a Revision Total Hip Arthroplasty Requiring Calcar Reconstruction.

作者信息

Ishiguro Shigeo, Asanuma Kunihiro, Tamaki Tatsuya, Oinuma Kazuhiro, Sudo Akihiro

机构信息

Orthopaedic Surgery, Kameyama Medical Center, Mie, Japan.

Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan.

出版信息

Case Rep Orthop. 2021 Feb 27;2021:8811593. doi: 10.1155/2021/8811593. eCollection 2021.

DOI:10.1155/2021/8811593
PMID:33728081
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7937483/
Abstract

INTRODUCTION

In cases of bone deficiency or osteoporosis, and especially in revision cases, there were only two options for treatment until the impaction bone graft procedure was proposed. These were cemented or cementless femoral prosthesis. In the early 1990s, the use of impaction bone graft with a cemented mantle had gained popularity and had proven to be clinically effective. In Germany, a cementless impaction bone graft procedure using Corail® (DePuy Synthes) stems was devised, and functional scores were similar to conventional cemented Impaction bone grafts. . A 48-year-old man presented with femur loosening of a reamed bipolar arthroplasty performed in 1990. The patient was treated with a cementless impaction bone graft using a Corail® (DePuy Synthes) stem in the femur in revision THA surgery, and the calcar was reconstructed by allograft.

RESULTS

At five years, the calcar allograft united with the host bone, and the femoral component showed no subsidence.

CONCLUSION

Calcar reconstruction with a strut allograft, aimed at preventing sinking of the stem was key in this operation. Surgical indication for femoral cementless impaction bone graft should be for loosened femoral prosthesis in a type II Paprosky classification, where only the cortical bone of the isthmus is partially affected, cortical thinning does not exist, and it is mechanically strong enough for the allograft tip impaction. The procedure was safely feasible through the direct anterior approach.

摘要

引言

在骨缺损或骨质疏松的病例中，尤其是翻修病例，在提出打压植骨手术之前，治疗方法只有两种选择。即骨水泥型或非骨水泥型股骨假体。在20世纪90年代早期，带骨水泥套的打压植骨的应用开始普及，并已被证明在临床上是有效的。在德国，设计了一种使用Corail®（德普伊辛迪思）柄的非骨水泥打压植骨手术，其功能评分与传统的骨水泥型打压植骨相似。一名48岁男性，1990年接受了扩髓双极关节置换术，现出现股骨松动。在翻修全髋关节置换手术中，该患者股骨采用Corail®（德普伊辛迪思）柄进行非骨水泥打压植骨治疗，并通过同种异体骨重建股骨距。

结果

五年时，股骨距同种异体骨与宿主骨愈合，股骨组件无下沉。

结论

采用支撑性同种异体骨重建股骨距以防止柄下沉是该手术的关键。股骨非骨水泥打压植骨的手术适应证应为Paprosky II型分类中股骨假体松动的情况，即仅峡部皮质骨部分受累，不存在皮质变薄，且机械强度足以进行同种异体骨末端打压。该手术通过直接前路安全可行。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/679cd6a7a20b/CRIOR2021-8811593.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/c70c5541024d/CRIOR2021-8811593.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/d1cd5a263822/CRIOR2021-8811593.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/e436e0f64665/CRIOR2021-8811593.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/679cd6a7a20b/CRIOR2021-8811593.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/c70c5541024d/CRIOR2021-8811593.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/d1cd5a263822/CRIOR2021-8811593.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/e436e0f64665/CRIOR2021-8811593.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/956b/7937483/679cd6a7a20b/CRIOR2021-8811593.004.jpg

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本文引用的文献

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J Arthroplasty. 2017 Nov;32(11):3421-3428. doi: 10.1016/j.arth.2017.05.056. Epub 2017 Jun 8.
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What Is the Difference Between Modular and Nonmodular Tapered Fluted Titanium Stems in Revision Total Hip Arthroplasty.翻修全髋关节置换术中模块化与非模块化锥形带槽钛柄的区别是什么。
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Femoral impaction bone grafting in revision hip arthroplasty: 705 cases from the originating centre.
髋关节翻修术中的股骨嵌压植骨术：来自原发中心的705例病例
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