[1]骆晓飞,王金良,王少华,等.金属垫块修复PaproskyⅢ型髋臼骨缺损在人工髋关节翻修术中的应用[J].中医正骨,2020,32(07):43-46.
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金属垫块修复PaproskyⅢ型髋臼骨缺损在人工髋关节翻修术中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年07期
页码:
43-46
栏目:
临床报道
出版日期:
2020-07-20

文章信息/Info

作者:
骆晓飞王金良王少华蔡松涛孙京涛魏瑄
郑州市骨科医院,河南 郑州 450052
关键词:
关节成形术置换 再手术 髋臼 骨缺损 金属垫块
摘要:
目的:观察人工髋关节翻修术中应用金属垫块修复PaproskyⅢ型髋臼骨缺损的临床疗效与安全性。方法:2016年1月至2018年11月,采用人工髋关节翻修术治疗初次全髋关节置换术(total hip arthroplasty,THA)后假体无菌性松动患者34例,术中均采用金属垫块修复髋臼骨缺损。男21例,女13例。年龄53~84岁,中位数68.5岁。左侧19例,右侧15例。髋臼骨缺损根据Paprosky分型,ⅢA型28例、ⅢB型6例。初次THA距本次翻修手术时间6~16年,中位数8年。记录手术时间、术中出血量。采用Harris髋关节评分、视觉模拟量表(visual analogue scale,VAS)评分评价临床疗效。测量术前与术后1年髋臼中心的垂直距离与水平距离。观察治疗及随访期间并发症发生情况。结果:34例患者手术均顺利完成,手术时间(141.88±9.14)min,术中出血量(571.88±60.91)mL。单纯髋臼翻修12例,全髋关节翻修22例。所有患者均获随访,随访时间12~45个月,中位数26个月。Harris髋关节评分,术前(46.55±10.28)分、术后3个月(65.71±11.25)分、术后6个月(76.04±9.35)分、术后1年(84.19±6.81)分。髋关节疼痛VAS评分,术前(4.11±1.04)分、术后3个月(1.05±0.21)分、术后6个月(0.94±0.17)分、术后1年(1.02±0.24)分。髋臼中心垂直距离,患侧术前(33.68±4.19)mm、术后1年(23.31±2.17)mm,健侧(15.31±2.24)mm,患侧术后1年较健侧上移(8.27±2.65)mm; 髋臼中心水平距离,患侧术前(26.47±3.92)mm、术后1年(33.01±3.15)mm,健侧(33.46±1.97)mm。末次随访时,金属垫块与骨面紧密接触,骨长入良好; 均未发生金属垫块移位、螺钉断裂、骨溶解、感染及假体周围骨折等并发症。结论:人工髋关节翻修术中采用金属垫块修复PaproskyⅢ型髋臼骨缺损,能够恢复髋关节解剖结构,改善髋关节功能,且安全性高。

参考文献/References:

[1] 钱涛,夏永法.老年全髋关节置换术中联合应用氨甲环酸和利伐沙班的临床研究[J].中医正骨,2019,31(1):10-13.
[2] PAPROSKY W G,PERONA P G,LAWRENCE J M.Acetabular defect classification and surgical reconstruction in revision arthroplasty.A 6-year follow-up evaluation[J].J Arthroplasty,1994,9:33-44.
[3] GARCÍA-REY E,MADERO R,GARCÍA-CIMBRELO E.THA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects[J].Clin Orthop Relat Res,2015,473(12):3882-3891.
[4] KHLOPAS A,CHUGHTAI M,ELMALLAH R K,et al.Novel acetabular cup for revision THA improves hip center of rotation:a radiographic evaluation[J].Clin Orthop Relat Res,2018,476(2):315-322.
[5] 马立峰,吴杰,郭艾,等.3D打印钛金属加强块重建全髋关节翻修术中髋臼骨缺损的近期临床疗效研究[J].国际外科学杂志,2019,46(3):172-176.
[6] 陈哲峰,范卫民,王青,等.同种异体颗粒骨打压植骨钛网杯重建髋臼骨缺损的疗效[J].中华骨科杂志,2016,36(23):1512-1516.
[7] 毛宾尧,庞清江,吕厚山.人工髋关节外科学[M].2版.北京:人民卫生出版社,2010:154.
[8] 吴晗,白文艺,程文丹,等.直接前入路与后外侧入路全髋关节置换术围手术期隐性失血量的比较研究[J].中医正骨,2019,31(9):7-10.
[9] BROWN N M,MORRISON J,SPORER S M,et al.The use of structural distal femoral allograft for acetabular reconstruction of Paprosky type ⅢA defects at a mean 21 years of follow-up[J].J Arthroplasty,2016,31(3):680-683.
[10] MÄKINEN T J,ABOLGHASEMIAN M,WATTS E,et al.Management of massive acetabular bone defects in revision arthroplasty of the hip using a reconstruction cage and porous metal augment[J].Bone Joint J,2017,99-B(5):607-613.
[11] DEL GAIZO D J,KANCHERLA V,SPORER S M,et al.Tantalum augments for Paprosky IIIA defects remain stable at midterm followup[J].Clin Orthop Relat Res,2012,470(2):395-401.
[12] LING T X,LI J L,ZHOU K,et al.The use of porous tantalum augments for the reconstruction of acetabular defect in primary total hip arthroplasty[J].J Arthroplasty,2018,33(2):453-459.
[13] LAAKSONEN I,LORIMER M,GROMOV K,et al.Does the risk of rerevision vary between porous tantalum cups and other cementless designs after revision hip arthroplasty?[J].Clin Orthop Relat Res,2017,475(12):3015-3022.
[14] DU Y Q,ZHOU Y G,PIAO S,et al.Effects of trabecular metal augments for the reconstruction of Paprosky type Ⅲ acetabulum bone defects[J].Chin J Surg,2017,55(6):410-415.
[15] KIM Y H,PARK J W,KIM J S,et al.High survivorship with cementless stems and cortical strut allografts for large femoral bone defects in revision THA[J].Clin Orthop Relat Res,2015,473(9):2990-3000.
[16] BERASI 4th C C,BEREND K R,ADAMS J B,et al.Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss?[J].Clin Orthop Relat Res,2015,473(2):528-535.
[17] 郭予立,胡奕山,刁喜财,等.钛金属垫块结合钛髋臼杯治疗髋臼骨缺损疗效观察[J].海南医学,2019,30(9):1120-1123.
[18] 黎庆钿,林博夫,陈学潘,等.3D技术辅助钽金属块植入修复严重髋臼骨缺损的早期疗效[J].中华骨科杂志,2020,40(3):129-137.
[19] JENKINS D R,ODLAND A N,SIERRA R J,et al.Minimum five-year outcomes with porous tantalum acetabular cup and augment construct in complex revision total hip arthroplasty[J].J Bone Joint Surg Am,2017,99(10):e49.
[20] LÖCHEL J,JANZ V,HIPFL C,et al.Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up[J].Bone Joint J,2019,101-B(3):311-316.
[21] FOUSEK J,INDRAKOVA P.Total hip arthroplasty in post-dysplastic hip arthritis.Can type and position of the acetabular component influence longevity of the prosthesis?[J].Acta Chir Orthop Traumatol Cech,2007, 74(1):47-54.
[22] LACHIEWICZ P F,O'DELL J A.Tantalum components in difficult acetabular revisions have good survival at 5 to 10 years:longer term followup of a previous report[J].Clin Orthop Relat Res,2018,476(2):336-342.

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备注/Memo

备注/Memo:
基金项目:河南省科技攻关计划项目(182102310690); 河南省中医药科学研究专项课题(2017ZY3010) 通讯作者:魏瑄 E-mail:13598802880@163.com
更新日期/Last Update: 2020-07-20