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钽金属骨小梁臼杯联合钽金属加强块重建Paprosky Ⅲ型髋臼骨缺损的近期疗效

Early outcomes of reconstruction of Paprosky Ⅲ acetabular bone defects using tantalum trabecular metal cup combined with tantalum augment

摘要:

目的 探讨钽金属骨小梁臼杯联合钽金属加强块重建严重髋臼骨缺损的近期疗效.方法 2014年4月至2015年12月应用钽金属骨小梁臼杯联合钽金属加强块重建PaproskyⅢ型髋臼缺损23例24髋,男11例12髋,女12例12髋;年龄38~65岁,平均54岁.20例为全髋关节翻修术,4例为初次全髋关节置换术.术中尽量重建髋臼环形支撑,不能重建时依据“三点固定”原理使臼杯在三角形分布的三个支点上获得稳定,通过钽金属骨小梁臼杯和钽金属加强块的不同组合,重建髋臼“环”或支撑“点”,辅助臼杯获得初始稳定性并重建髋关节旋转中心.术后随访时评估Harris髋关节评分、西安大略和麦克马斯特大学(Western Ontario and McMaster Universities,WOMAC)骨关节炎指数,统计术中血管、神经损伤和术后假体周围感染、脱位、假体周围骨折等严重并发症的发生情况,通过X线片测量髋关节旋转中心高度和水平位置.结果 随访7~28个月,平均16个月.Harris髋关节评分由术前(35.3±12.1)分提高至末次随访的(82.7±8.3)分(t=-16.991,P<0.001).WOMAC骨关节炎指数由术前(39.1±24.0)分提高至末次随访的(87.2±11.4)分(t=-7.671,P<0.001).患侧旋转中心高度由术前(44.02±11.65) mm降至术后(22.96±8.24) mm(t=6.458,P<0.001).随访期间钽金属骨小梁臼杯及钽金属加强块均稳定,无移位及松动,无假体相关感染及脱位,无神经损伤和假体周围骨折等并发症.结论 钽金属骨小梁臼杯联合钽金属加强块重建PaproskyⅢ型髋臼骨缺损能够获得良好的初始稳定性,重建髋关节生物力学,术后近期疗效良好.

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abstracts:

Objective To investigate the early outcomes of reconstruction of severe acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment in total hip replacement.Methods From April 2014 to December 2015,23 patients (24 hips) underwent total hip arthroplasty by the use of tantalum trabecular metal cups combined with tantalum augments.There were 11 males (12 hips) and 12 females (12 hips),with the average age 54 years (range,38-65 years).We tried to reconstruct an annular support for the cup.If an annular support cannot be reconstructed,the cup obtains primary stability based on the three point fixation rationale.Flexible placing of the TM cup combined with the augments helped reconstruction of the socket ring or supporting points,thus achieving rigid primary stability of the cup and restoring center of rotation.Harris hip score and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score were recorded.Any severe intraoperative complications including vascular or nerve injury and severe postoperative complications such as periprosthetic joint infection,dislocation or periprosthetic fracture were reported.The vertical position of the center of rotation from the interteardrop line and the horizontal position of the center of rotation from the teardrop were measured and analyzed.Results The average follow-up duration was 16 months (range,7-28 months).The mean Harris hip score was 35.3±12.1 preoperatively and 82.7±8.3 postoperatively (t=-16.991,P<0.001).The mean WOMAC score was 39.1 ±24.0 preoperatively and 87.2± 11.4 postoperatively (t=-7.671,P< 0.001).The average vertical location of the center of rotation was 44.02± 11.65 mm preoperatively and 22.96±8.24 mm postoperatively.All the tantalum cups and augments were stable.There was no periprosthetic joint infection,dislocation,nerve injury or periprosthetic fracture.Conclusion Reconstruction of Paprosky Ⅲ acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment can achieve good primary stability and restore the center of rotation with almost normal hip biomechanics.The short-term outcomes are satisfied.

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作者: 郭盛杰 [1] 黄勇 [1] 唐浩 [1] 顾建明 [1] 杨德金 [1] 周一新 [1]
期刊: 《中华骨科杂志》2016年36卷23期 1479-1486页 ISTICPKUCSCD
栏目名称: 髋臼重建
DOI: 10.3760/cma.j.issn.0253-2352.2016.23.003
发布时间: 2017-01-07
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