| 赵吉辉,杨卿,郭风劲.颗粒打压植骨联合金属钛网应用于中度髋臼缺损髋翻修的早期研究.骨科,2018,9(1): 7-13. |
| 颗粒打压植骨联合金属钛网应用于中度髋臼缺损髋翻修的早期研究 |
| An early stage study of the clinical outcomes of THA revisions using impaction allografting with metallic mesh for moderate acetabular defects |
| 投稿时间：2017-10-09 |
| DOI：10.3969/j.issn.1674-8573.2018.01.002 |
| 中文关键词: 全髋关节翻修术 金属钛网 髋臼 骨缺损 打压植骨 |
| 英文关键词: Revision total hip arthroplasty Metallic mesh Acetabular Bone defect Impacted graft |
| 基金项目:湖北省技术创新专项重大项目（2016ACA149） |
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| 中文摘要: |
| 目的 分析颗粒松质骨打压植骨联合金属钛网应用于伴有中度髋臼骨缺损的全髋关节翻修术的早期临床效果，并比较该方法用于不同类型骨缺损的效果差异。方法 回顾性分析我院2008年7月至2015年3月采用金属钛网联合颗粒骨打压植骨技术行髋臼骨缺损翻修重建的19例（19髋）病人的临床资料，其中男8例，女11例。骨缺损采用Paprosky分型：ⅡB型7例，ⅡC型11例，ⅢA型1例。通过术后定期复查的髋部X线片评估术后的移植骨整合情况、假体稳定性及髋关节旋转中心的位置；分析比较病人手术前后各时间点的改良髋关节Harris评分（hip Harris score, HHS）及SF-36生活质量评分；采用Kaplan-Meier法对假体进行生存分析；比较ⅡB和ⅡC型骨缺损病人在上述指标方面的差异。结果 19例病人随访10~76个月，平均随访时间为4.7年。19例病人的移植骨状况良好，和宿主骨不同程度整合；1例病人因假体周围感染致假体松动行再次翻修；所有病人髋臼旋转中心均得到了良好重建；HHS评分由术前的（47.51±5.91）分提高至末次随访时的（90.30±5.53）分，差异有统计学意义（t=17.005，P=0.010）；SF-36生活质量评分术后也得到了显著提高；术后4.7年以再次翻修为研究终点的假体生存率为94.7%。ⅡB和ⅡC型骨缺损病人在上述指标的差异均无统计学意义（P均＞0.05）。结论 金属钛网联合颗粒松质骨打压植骨用于伴有骨缺损的髋关节翻修，早期临床效果良好，且对于Paprosky ⅡB和ⅡC型髋臼缺损的疗效相当。 |
| 英文摘要: |
| Objective To analyze the early stage clinical outcomes of impaction allografting with metallic mesh used in THA revision for moderate acetabular defects, and to compare the difference between different acetabular defect types. Methods A retrospective analysis was performed on 19 hips (19 patients: 8 males, and 11 females) with moderate acetabular deficiencies that were treated with impaction allografting and metallic mesh in our hospital between July 2008 and March 2015. According to the Paprosky classification for the acetabular defects, there were 7 cases of Paprosky ⅡB, 11 cases of Paprosky ⅡC and 1 case of Paprosky ⅢA. The integration of graft bone, prosthesis stability and location of hip rotation center were evaluated by regular X-ray examination postoperatively. The hip Harris score (HHS), and SF-36 life quality score at different time points before and after operation were compared. Kaplan-Meier method was used to analyze the prosthesis survival. The differencesin these indexes between ⅡB and ⅡC patients were compared. Results Total 19 patients were followedup for 10-76 months (mean 4.7 years). All the 19 patients got good bone graft situation with different degrees of integration. Except 1 patient had revision again for prosthesis loosening caused by periprosthetic joint infection, all the other patients had good restoration of hip rotation center. The HHS was improved from 47.51±5.91 to 90.30±5.53 at the last follow-up, and the difference was statistically significant (t=17.005, P=0.010). The SF-36 life quality score was also improved obviously. The survival rate for revision was 94.7% during a mean follow-up period of 4.7 years postoperation. The ⅡB and ⅡC patients had no statistically significant difference (P＞0.05 for all). Conclusion Impaction allografting with metallic mesh can be used in the revision of hip with bone defect, especially for PaproskyⅡB and ⅡC types, with good early stage clinical outcomes and there is no significant difference between them. |
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