同种异体骨颗粒填塞植骨联合Jumbo臼杯在中重度髋臼骨缺损髋关节翻修中的应用
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摘要
目的观察大号生物杯(Jumbo臼杯)联合同种异体骨颗粒填塞植骨在全髋关节翻修术中对中重度髋臼侧骨缺损进行重建的疗效。方法收集我院2011年9月至2016年6月,采用Jumbo臼杯联合颗粒同种异体骨颗粒填塞植骨重建26例(26髋)中、重度髋臼骨缺损髋关节翻修患者的临床资料。男13例,女13例,年龄35～81岁,平均(62.3±12.4)岁。初次人工全髋关节置换术至翻修术间隔1～25年,平均8.42年。髋关节翻修原因:无菌性松动24例,假体周围感染2例。骨缺损根据Paprosky分型标准,IIA型7例,IIB型7例,IIC型11例,IIIA型1例。评价术前、术后的髋关节Harris评分、疼痛视觉模拟评分(visual analogue scale,VAS);在X线片上评价髋关节旋转中心、髋臼外展角、股骨偏心距以及植骨融合情况,并判断髋臼有无松动和移位、生存率情况及并发症。同种异体股骨头由山西奥瑞公司提供。结果全部病例均获得随访,随访时间24～83个月,平均53.3个月。Harris评分:术前(51.88±3.41)分,末次随访(85.38±3.47)分(P<0.05);VAS评分:术前(6.23±0.91)分,术后(0.62±0.63)分(P<0.05);患侧髋关节旋转中心高度:术前(3.26±0.96) cm,末次随访(2.67±0.64) cm (P<0.05);患侧髋臼外展角:术前(50.68±7.88)°,术后(40.75±5.56)°(P<0.05);股骨偏心距:术前(41.54±6.13)°,术后(46.39±7.57)°(P<0.05)。随访期内Jumbo臼杯固定良好,未出现松动及移位,髋臼杯均出现不同程度骨长入,均未发现臼杯周围透光线、骨溶解,假体生存率100.0%。结论在髋关节翻修中使用Jumbo臼杯联合同种异体骨颗粒填塞植骨治疗髋臼侧骨缺损能提供早期稳定性,尽可能恢复股骨偏心距、髋关节旋转中心及骨量储备,短期随访临床效果良好。
Objective To observe effects of Jumbo Cup combined with allogeneic bone squeezing and bone grafting on hip joint revision of moderate-severe acetabular bone defect. Methods Clinical data of 26 patients (26 hips) were collected. All underwent total hip arthroplasty revision with the Jumbo Cup combined with allogeneic bone grafting to reconstruct the acetabular bone defect in our hospital from September 2011 to June 2016. There were 13 males and 13 females, aged 35-81 years (mean: 62.3 ± 12.4 years) old. The interval of primary total hip arthroplasty to revision surgery was 1-25 years, with an average of 8.42 years. Causes of hip revision: aseptic loosening (24 cases); infection around the prosthesis (2 cases). According to the Paprosky classification criteria,bone defects were found in 7 cases of type IIA, 7 cases of type IIB, 11 cases of type IIC, and 1 case of type IIIA. The preoperative and postoperative hip Harris scores and visual analogue scale (VAS) were evaluated. The hip rotation center, acetabular abduction angle, femoral offset and bone graft fusion were evaluated on X-ray films to determine acetabulum loosening or displacement, prosthesis survival rate and surgical complications. The allogeneic femoral head was provided by Shanxi OsteoRad Co., Ltd. Results All patients were followed up for 24-83 months with an average of 53.3 months. The preoperative Harris score was (51.88 ± 3.41), which increased to (85.38 ± 3.47)at he last follow-up (P < 0.05). The preoperative VAS score was (6.23 ± 0.91), which reduced to (0.62 ± 0.63)postoperatively (P < 0.05). The preoperative height of the hip joint rotation center was (3.26 ± 0.96) cm, which reduced to (2.67 ± 0.64) cm at the last follow-up (P < 0.05). Preoperative acetabular abduction angle was (50.68 ±7.88) °, which reduced to (40.75 ± 5.56) ° postoperatively (P < 0.05). Preoperative femoral eccentricity was (41.54 ± 6.13) °, which increased to (46.39 ± 7.57) ° (P < 0.05). Jumbo cup was well fixed during the follow-up,no loosening or displacement occurred. Bone ingrow in the acetabular cup was observed. No light transmission line or osteolysis around the cup was found. The survival rate of the prosthesis was 100.0%. Conclusions Reconstruction of acetabular bone defect in total hip arthroplasty revision with large biological acetabular cup (Jumbo cup) combined with allogeneic bone grafting can provide early stability and restore femoral offset. The hip rotation center and bone mass are reserved. Short-term follow-up shows good clinical effects.
Objective To observe effects of Jumbo Cup combined with allogeneic bone squeezing and bone grafting on hip joint revision of moderate-severe acetabular bone defect. Methods Clinical data of 26 patients (26 hips) were collected. All underwent total hip arthroplasty revision with the Jumbo Cup combined with allogeneic bone grafting to reconstruct the acetabular bone defect in our hospital from September 2011 to June 2016. There were 13 males and 13 females, aged 35-81 years (mean: 62.3 ± 12.4 years) old. The interval of primary total hip arthroplasty to revision surgery was 1-25 years, with an average of 8.42 years. Causes of hip revision: aseptic loosening (24 cases); infection around the prosthesis (2 cases). According to the Paprosky classification criteria,bone defects were found in 7 cases of type IIA, 7 cases of type IIB, 11 cases of type IIC, and 1 case of type IIIA. The preoperative and postoperative hip Harris scores and visual analogue scale (VAS) were evaluated. The hip rotation center, acetabular abduction angle, femoral offset and bone graft fusion were evaluated on X-ray films to determine acetabulum loosening or displacement, prosthesis survival rate and surgical complications. The allogeneic femoral head was provided by Shanxi OsteoRad Co., Ltd. Results All patients were followed up for 24-83 months with an average of 53.3 months. The preoperative Harris score was (51.88 ± 3.41), which increased to (85.38 ± 3.47)at he last follow-up (P < 0.05). The preoperative VAS score was (6.23 ± 0.91), which reduced to (0.62 ± 0.63)postoperatively (P < 0.05). The preoperative height of the hip joint rotation center was (3.26 ± 0.96) cm, which reduced to (2.67 ± 0.64) cm at the last follow-up (P < 0.05). Preoperative acetabular abduction angle was (50.68 ±7.88) °, which reduced to (40.75 ± 5.56) ° postoperatively (P < 0.05). Preoperative femoral eccentricity was (41.54 ± 6.13) °, which increased to (46.39 ± 7.57) ° (P < 0.05). Jumbo cup was well fixed during the follow-up,no loosening or displacement occurred. Bone ingrow in the acetabular cup was observed. No light transmission line or osteolysis around the cup was found. The survival rate of the prosthesis was 100.0%. Conclusions Reconstruction of acetabular bone defect in total hip arthroplasty revision with large biological acetabular cup (Jumbo cup) combined with allogeneic bone grafting can provide early stability and restore femoral offset. The hip rotation center and bone mass are reserved. Short-term follow-up shows good clinical effects.
引文
[1]Beckmann NA,Gotterbarm T,Innmann MM,et al.Longterm durability of alumina ceramic heads in THA[J].BMCMusculoskelet Disord,2015,16:249.
[2]Capon-Garcia D,Lopez-Pardo A,Alves-Perez MT.Causes for revision surgery in total hip replacement.A retrospective epidemiological analysis[J].Rev Esp Cir Ortop Traumatol,2016,60(3):160-166.
[3]Martin CT,Callaghan JJ,Gao Y,et al.What can we learn from20-year followup studies of hip replacement[J]?Clin Orthop Relat Res,2016,474(2):402-407.
[4]Barlow BT,Boles JW,Lee YY,et al.Short-term outcomes and complications after rejuvenate modular total hip arthroplasty revision[J].J Arthroplasty,2016,31(4):857-862.
[5]Jain S,Grogan RJ,Giannoudis PV.Options for managing severe acetabular bone loss in revision hip arthroplasty.Asystematic review[J].Hip Int,2014,24(2):109-122.
[6]Gustke KA,Levering MF,Miranda MA.Use of jumbo cups for revision of acetabulae with large bony defects[J].J Arthroplasty,2014,29(1):199-203.
[7]Abolghasemian M,Tangsataporn S,Sternheim A,et al.Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss:a mid-term review[J].Bone Joint J,2013,95-B(2):166-172.
[8]Paprosky WG,Perona PG,Lawrence JM.Acetabular defect classification and surgical reconstruction in revision arthroplasty.A 6-year follow-up evaluation[J].J Arthroplasty,1994,9(1):33-44.
[9]Bourne RB,Rorabeck CH.Soft tissue balancing:the hip[J].J Arthroplasty,2002,17(4 Suppl 1):S17-22.
[10]DeLee JG,Charnley J.Radiological demarcation of cemented sockets in total hip replacement[J].Clin Orthop Relat Res,1976,(121):20-32.
[11]Moore MS,McAuley JP,Young AM,et al.Radiographic signs of osseointegration in porous-coated acetabular components[J].Clin Orthop Relat Res,2006,(444):176-183.
[12]Dearborn JT,Harris WH.Acetabular revision arthroplasty using so-called jumbo cementless components:an average 7-year follow-up study[J].J Arthroplasty,2000,15(1):8-15.
[13]田雷,边瑞祥,孙水,等.Jumbo臼杯处理髋关节翻修术中髋臼骨缺损的早期疗效观察[J].中华关节外科杂志(电子版),2017,11(4):427-433.
[14]Lachiewicz PF,Soileau ES.Fixation,survival,and dislocation of jumbo acetabular components in revision hip arthroplasty[J].J Bone Joint Surg Am,2013,95(6):543-548.
[15]Wedemeyer C,Neuerburg C,Heep H,et al.Jumbo cups for revision of acetabular defects after total hip arthroplasty:a retrospective review of a case series[J].Arch Orthop Trauma Surg,2008,128(6):545-550.
[16]Waddell BS,Della VA.Reconstruction of non-contained acetabular defects with impaction grafting,a reinforcement mesh and a cemented polyethylene acetabular component[J].Bone Joint J,2017,99B(1 Supple A):S25-30.
[17]Philippe R,Gosselin O,Sedaghatian J,et al.Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss:survival analysis of 95 hips after 5 to 13 years[J].Orthop Traumatol Surg Res,2012,98(2):129-137.
[18]van der Donk S,Buma P,Slooff T J,et al.Incorporation of morselized bone grafts:a study of 24 acetabular biopsy specimens[J].Clin Orthop Relat Res,2002,(396):131-141.
[19]Gilbody J,Taylor C,Bartlett GE,et al.Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement:a minimum ten-year follow-up study[J].Bone Joint J,2014,96B(2):188-194.
[20]Sakalkale DP,Sharkey PF,Eng K,et al.Effect of femoral component offset on polyethylene wear in total hip arthroplasty[J].Clin Orthop Relat Res,2001,(388):125-134.
[2]Capon-Garcia D,Lopez-Pardo A,Alves-Perez MT.Causes for revision surgery in total hip replacement.A retrospective epidemiological analysis[J].Rev Esp Cir Ortop Traumatol,2016,60(3):160-166.
[3]Martin CT,Callaghan JJ,Gao Y,et al.What can we learn from20-year followup studies of hip replacement[J]?Clin Orthop Relat Res,2016,474(2):402-407.
[4]Barlow BT,Boles JW,Lee YY,et al.Short-term outcomes and complications after rejuvenate modular total hip arthroplasty revision[J].J Arthroplasty,2016,31(4):857-862.
[5]Jain S,Grogan RJ,Giannoudis PV.Options for managing severe acetabular bone loss in revision hip arthroplasty.Asystematic review[J].Hip Int,2014,24(2):109-122.
[6]Gustke KA,Levering MF,Miranda MA.Use of jumbo cups for revision of acetabulae with large bony defects[J].J Arthroplasty,2014,29(1):199-203.
[7]Abolghasemian M,Tangsataporn S,Sternheim A,et al.Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss:a mid-term review[J].Bone Joint J,2013,95-B(2):166-172.
[8]Paprosky WG,Perona PG,Lawrence JM.Acetabular defect classification and surgical reconstruction in revision arthroplasty.A 6-year follow-up evaluation[J].J Arthroplasty,1994,9(1):33-44.
[9]Bourne RB,Rorabeck CH.Soft tissue balancing:the hip[J].J Arthroplasty,2002,17(4 Suppl 1):S17-22.
[10]DeLee JG,Charnley J.Radiological demarcation of cemented sockets in total hip replacement[J].Clin Orthop Relat Res,1976,(121):20-32.
[11]Moore MS,McAuley JP,Young AM,et al.Radiographic signs of osseointegration in porous-coated acetabular components[J].Clin Orthop Relat Res,2006,(444):176-183.
[12]Dearborn JT,Harris WH.Acetabular revision arthroplasty using so-called jumbo cementless components:an average 7-year follow-up study[J].J Arthroplasty,2000,15(1):8-15.
[13]田雷,边瑞祥,孙水,等.Jumbo臼杯处理髋关节翻修术中髋臼骨缺损的早期疗效观察[J].中华关节外科杂志(电子版),2017,11(4):427-433.
[14]Lachiewicz PF,Soileau ES.Fixation,survival,and dislocation of jumbo acetabular components in revision hip arthroplasty[J].J Bone Joint Surg Am,2013,95(6):543-548.
[15]Wedemeyer C,Neuerburg C,Heep H,et al.Jumbo cups for revision of acetabular defects after total hip arthroplasty:a retrospective review of a case series[J].Arch Orthop Trauma Surg,2008,128(6):545-550.
[16]Waddell BS,Della VA.Reconstruction of non-contained acetabular defects with impaction grafting,a reinforcement mesh and a cemented polyethylene acetabular component[J].Bone Joint J,2017,99B(1 Supple A):S25-30.
[17]Philippe R,Gosselin O,Sedaghatian J,et al.Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss:survival analysis of 95 hips after 5 to 13 years[J].Orthop Traumatol Surg Res,2012,98(2):129-137.
[18]van der Donk S,Buma P,Slooff T J,et al.Incorporation of morselized bone grafts:a study of 24 acetabular biopsy specimens[J].Clin Orthop Relat Res,2002,(396):131-141.
[19]Gilbody J,Taylor C,Bartlett GE,et al.Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement:a minimum ten-year follow-up study[J].Bone Joint J,2014,96B(2):188-194.
[20]Sakalkale DP,Sharkey PF,Eng K,et al.Effect of femoral component offset on polyethylene wear in total hip arthroplasty[J].Clin Orthop Relat Res,2001,(388):125-134.