中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (4): 493-498.doi: 10.12307/2022.081

• 组织工程骨材料Tissue-engineered bone •    下一篇

可降解高纯度镁金属骨钉固定修复发育性髋关节发育不良

黄诗博1,2,谢  辉2,王宗璞2,王韦丹2,覃开蓉1,赵德伟1,2   

  1. 1大连理工大学电信学部生物医学工程学院,辽宁省大连市   116001;2大连大学附属中山医院骨科,辽宁省大连市   116001
  • 收稿日期:2021-01-25 修回日期:2021-01-27 接受日期:2021-02-23 出版日期:2022-02-08 发布日期:2021-11-03
  • 通讯作者: 赵德伟,博士,主任医师,博士生导师,大连理工大学电信学部生物医学工程学院,辽宁省大连市 116001;大连大学附属中山医院骨科,辽宁省大连市
  • 作者简介:黄诗博,男,1985年生,辽宁省抚顺市人,汉族,硕士,主治医师,主要从事关节及运动医学研究。
  • 基金资助:
    国家卫生部公益项目(201402016),项目名称:基于显微外科的严重肢体组织缺损修复关键技术的优化,规范与评价研究,项目负责人:赵德伟;国家自然科学基金(81672139),项目名称:可降解纯镁植入螺钉促进缺血性坏死股骨头修复的机理研究”,项目负责人:赵德伟

Application of degradable high-purity magnesium screw in the treatment of developmental dysplasia of the hip

Huang Shibo1, 2, Xie Hui2, Wang Zongpu2, Wang Weidan2, Qin Kairong1, Zhao Dewei1, 2   

  1. 1School of Biomedical Engineering, Department of Telecommunication, Dalian University of Technology, Dalian 116001, Liaoning Province, China; 2Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • Received:2021-01-25 Revised:2021-01-27 Accepted:2021-02-23 Online:2022-02-08 Published:2021-11-03
  • Contact: Zhao Dewei, MD, Chief physician, Doctoral supervisor, School of Biomedical Engineering, Department of Telecommunication, Dalian University of Technology, Dalian 116001, Liaoning Province, China; Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • About author:Huang Shibo, Master, Attending physician, School of Biomedical Engineering, Department of Telecommunication, Dalian University of Technology, Dalian 116001, Liaoning Province, China; Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, Liaoning Province, China
  • Supported by:
    the Public Welfare Project of the Ministry of Health of China, No. 201402016 (to ZDW); the National Natural Science Foundation of China, No. 81672139 (to ZDW) 

摘要:

文题释义:
髋臼外上方植骨:评估髋臼缺损大小后,选择适合大小的骨块进行移植填补髋臼部位,髋臼外上方结构性植骨可增加髋周骨量,既保证了髋臼的覆盖也保证了翻修时髋臼周围骨量,降低了翻修所面对的手术难度。
可降解高纯度镁金属骨内螺钉:可降解镁金属材料是新一代的可降解骨植入材料,较目前已临床应用的不锈钢、钛合金、钴基合金等不可降解金属材料有更接近骨组织的弹性模量,可避免应力屏蔽作用。
背景:发育性髋关节发育不良髋臼缺损患者选择接受全髋关节置换时,髋臼侧的处理对假体安放极为重要,髋臼外上方植骨被证实是一种安全可行的治疗方式,而如何进行植骨成为手术成功的关键因素。
目的:探讨在髋臼外上方采用可降解高纯度镁金属螺钉固定植骨联合全髋人工关节置换治疗发育性髋关节发育不良髋臼缺损患者的临床疗效。
方法:纳入大连大学附属中山医院收治的7例发育性髋关节发育不良髋臼缺损患者,其中男1例,女6例,年龄54-65岁,按Crowe分型2例Ⅰ型,1例Ⅱ型,2例Ⅲ型,2例Ⅳ型,均进行人工全髋关节置换手术,髋臼侧采用外上方植骨处理缺损增加覆盖,移植骨块采用可降解高纯度镁金属螺钉进行固定。术后随访进行影像学检查与髋关节Harris功能评分、目测类比评分。研究经过大连大学附属中山医院伦理委员会通过(批件号:2013-006)。
结果与结论:①7例患者随访2-4.5年,患肢短缩由术前的(2.43±0.78) cm下降至术后(0.57±0.56) cm,未见切口感染及不愈合发生,未见假体周围感染出现;②7例患者末次随访的目测类比评分低于术前(P < 0.05),髋关节功能Harris评分高于术前(P < 0.05);③影像学检查显示,可降解高纯度镁金属螺钉在术后三四年间全部降解,移植骨块均与髋臼骨性愈合,未见移植骨块脱落及假体松动,所有病例术后未见不良并发症发生;④结果表明,对于发育性髋关节发育不良髋臼缺损患者,在髋臼外上方采用可降解高纯度镁金属螺钉固定植骨联合全髋人工关节置换治疗的短期效果满意。

https://orcid.org/0000-0001-6848-2104 (黄诗博) 

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料口腔生物材料纳米材料缓释材料材料相容性;组织工程

关键词: 发育性髋关节发育不良, 全髋关节置换, 髋臼缺损, 生物型假体, 金属骨钉, 镁, 镁金属螺钉

Abstract: BACKGROUND: In the selection of total hip arthroplasty for acetabular defect patients with developmental dysplasia of the hip, the management of the acetabular side is very important for the placement of the prosthesis. The external and upper acetabular bone grafting has been proven to be a safe and feasible treatment method, and how to carry out the bone grafting has become the key factor for the success of the operation.
OBJECTIVE: To investigate the clinical effect of external and superior acetabular bone graft combined with total hip arthroplasty in the treatment of acetabular defect in patients with developmental dysplasia of the hip and fixation of bone graft with degradable high-purity magnesium metal screws.
METHODS: Seven cases of developmental dysplasia of the hip acetabulum defect patients, with 1 male and 6 females, aged 54-65 years, were included from the Affiliated Zhongshan Hospital of Dalian University. According to Crowe type, there were 2 cases of I type, 1 case of II type, 2 cases of III type, and 2 cases of IV type. All cases underwent artificial total hip arthroplasty. The acetabulum received external and upper acetabular bone grafting and the coverage. The bone grafts were fixed with biodegradable high-purity magnesium metal screw. The imaging examination, Harris hip functional score and visual analogue scale score were performed in the postoperative follow-up. This study was approved by the Ethics Committee of the Affiliated Zhongshan Hospital of Dalian University (approval No. 2013-006).
RESULTS AND CONCLUSION: (1) Seven patients were followed up for 2-4.5 years. The shortened affected limb decreased from (2.43±0.78) cm preoperatively to (0.57±0.56) cm postoperatively. No incision infection or nonunion was observed, and no periprosthetic infection was observed. (2) The visual analogue scale score at the last follow-up was lower than that before surgery in seven patients (P < 0.05). Harris score of hip function was higher than that before surgery (P < 0.05). (3) Imaging examination showed that all the degradable high-purity magnesium metal screws were degraded three or four years after surgery, and the graft bone healed with the acetabular bone. No graft loss or prosthesis loosening was observed. No postoperative adverse complications were observed in all cases. (4) The results showed that for the patients with acetabular defect with developmental dysplasia of the hip, the treatment with degradable high-purity magnesium metal screw fixation and total hip arthroplasty on the external and upper part of the acetabulum was satisfactory in the short term.

Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabulum defect, biological prosthesis, metal bone nail, magnesium, magnesium screw 

中图分类号: