Poitout D G, Tropiano P
Service de Chirurgie Orthopédique et Traumatologie, CHRU Hôpital Nord, Marseille.
Bull Acad Natl Med. 1996 Mar;180(3):515-28; discussion 528-31.
The hip revision surgery like oncology surgery may need massive allografts to rebuilt the acetabulum or an hemi pelvis. Since 1982 we have chosen to use deep frozen massive allografts instead of massive metallic prosthesis, resection, or osteosynthesis of the femur to the iliac bone or the sacrum. These last proposal seems for our patients too heavy, the functional results being always bad.
--37 Acetabulum reconstruction has been performed. (18 hemi-pelvis). --The follow-up is from 1 to 12 years with a medical of 5 years and 2 months. --The tumoral pathology (14 cases) was for 50% chondrosarcomas [7]. 6 infections (1 massive echinococcosis and 5 osteomyelitis) --17 hip reconstruction for revision surgery. We use deep frozen allografts cryopreserved with Dimethylsulfoxide 10%. No secondary irradiation. The allografts were used after securisation (after the 6th month after the procurement). Most for the time we used 2 platres, one posterior outside the pelvis, one anterior inside the pelvis. Screwed on the contralateral pubis bone and the sacrum. A hip prosthesis was used in almost all the cases. In tumoral cases, the results were excellent with chondrosarcomas but in the other cases metastasis and death were usually seen in the 2 or 3 years following the surgery. --3 instability of the prosthesis. --2 fractures of the allograft. In the non tumoral cases, the integration of the graft was excellent. --1 instability of the prosthesis needed a antiluxent crescent. --1 fracture of the graft needed adjonction of autografts and new osteosynthesis. --1 superficial infection. Good functional results has been obtained with the use of massive allografts. The fracture of the allografts can heal without a new operation. In some cases we have had some liquid surrounding the grafts which can be a immunological response.
髋关节翻修手术与肿瘤手术一样，可能需要大量同种异体骨来重建髋臼或半骨盆。自1982年以来，我们选择使用深冻大量同种异体骨，而非大量金属假体、股骨切除术或将股骨与髂骨或骶骨进行骨固定术。后几种方案对我们的患者而言似乎创伤过大，功能结果往往不佳。
已进行37例髋臼重建手术（18例半骨盆重建）。
随访时间为1至12年，平均为5年零2个月。
肿瘤病理学检查（14例）显示，50%为软骨肉瘤[7]。6例感染（1例巨大包虫病和5例骨髓炎）
17例髋关节重建用于翻修手术。我们使用用10%二甲基亚砜冷冻保存的深冻同种异体骨。未进行二次放疗。同种异体骨在获取后6个月确保安全后使用。大多数情况下我们使用2块钢板，一块置于骨盆后方外侧，一块置于骨盆前方内侧。用螺钉固定于对侧耻骨和骶骨。几乎所有病例均使用了髋关节假体。在肿瘤病例中，软骨肉瘤的结果极佳，但在其他病例中，通常在术后2至3年出现转移和死亡。
3例假体不稳定。
2例同种异体骨骨折。在非肿瘤病例中，移植物的融合情况极佳。
1例假体不稳定需要使用防脱位新月形钢板。
1例移植物骨折需要添加自体骨并进行新的骨固定术。
1例表浅感染。使用大量同种异体骨取得了良好的功能结果。同种异体骨骨折无需再次手术即可愈合。在某些情况下，移植物周围会有一些液体，这可能是一种免疫反应。
