中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (9): 1424-1428.doi: 10.12307/2022.440

• 人工假体Artificial prosthesis • 上一篇    下一篇

自体髂骨块联合钛板重建Paprosky Ⅲ型髋臼骨缺损为假体提供坚强的初始固定#br#

薛亚东1，周新社1，裴立家1，2，孟繁宇1，李  键1，王金子1   

  1. 蚌埠医学院第一附属医院，1骨科，2组织移植安徽省重点实验室，安徽省蚌埠市   233000
  • 收稿日期:2021-06-10 修回日期:2021-06-11 接受日期:2021-08-05 出版日期:2022-03-28 发布日期:2021-12-10
  • 通讯作者: 周新社，博士，副主任医师，蚌埠医学院第一附属医院骨科，安徽省蚌埠市 233000
  • 作者简介:薛亚东，男，1991年生，安徽省淮北市人，汉族，在读硕士，主要从事关节外科的治疗和研究。
  • 基金资助:
    蚌埠医学院自然科学重点项目(BYKY2019030ZD)，项目负责人：裴立家

Reconstruction of Paprosky III type acetabular defect by autogenous iliac bone block combined with titanium plate: providing a strong initial fixation for the prosthesis

Xue Yadong1, Zhou Xinshe1, Pei Lijia1, 2, Meng Fanyu1, Li Jian1, Wang Jinzi1    

  1. 1Department of Orthopedics, 2Anhui Key Laboratory of Tissue Transplantation, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
  • Received:2021-06-10 Revised:2021-06-11 Accepted:2021-08-05 Online:2022-03-28 Published:2021-12-10
  • Contact: Zhou Xinshe, MD, Associate chief physician, Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
  • About author:Xue Yadong, Master candidate, Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
  • Supported by:
    Natural Science Key Project of Bengbu Medical College, No. BYKY2019030ZD (to PLJ)

PDF

182

摘要：

文题释义：
Paprosky Ⅲ型髋臼骨缺损：指存在严重骨缺损的同时累及髋臼周围所有承重结构，旋转中心移位> 3 cm，并常伴有骨盆不连续，其中Ⅲa型指中重度骨缺损，累及整个髋臼缘及髋臼后柱，旋转中心向侧上方移位，30%-60% 承重骨骨量丢失；Ⅲb型指重度骨缺损，累及整个髋臼缘及前后柱，旋转中心向内上移位，60%以上承重骨骨量丢失。
Sharp角：即髋臼角，是双侧泪点下缘和泪点下缘与髋臼外上缘连接线夹角，通常2岁儿童为48°，4岁为42°，15岁以上应< 40°，若髋臼角大于正常值提示髋臼发育不良。

背景：近年来国内外针对于Paprosky Ⅲ型髋臼缺损的治疗研究取得了新的进展，常用的重建方法有钽金属垫块、髋臼加强杯-加强环、骨水泥髋臼假体及重建钢板和钛金属网等。
目的：探讨人工髋关节翻修治疗中应用自体髂骨块联合钛板重建Paprosky Ⅲ型髋臼骨缺损的临床疗效。
方法：选择2012年6月至2020年8月蚌埠医学院第一附属医院收治的髋关节翻修Paprosky Ⅲ型髋臼骨缺损患者15例，其中男9例，女6例，年龄47-78岁，均进行自体髂骨块联合钛板重建治疗，观察患者术后临床体征及X射线片表现。评价患者术前及末次随访时的Harris髋关节功能评分及目测类比评分，测量术后髋臼杯的前倾角、外展角及术后1周、末次随访时的髋关节中心边缘角、髋臼角，统计术后并发症发生情况。试验获得蚌埠医学院第一附属医院伦理委员会批准。
结果与结论：①15例患者均顺利完成手术，术后获得12-60个月随访，其中1例出现股外侧皮神经损伤症状，未出现钢板断裂、骨溶解、感染和假体周围骨折；②15例患者术后末次随访的Harris髋关节功能评分及目测类比评分均较术前明显改善(P < 0.05)；③15例患者术后髋臼杯前倾角和外展角分别为(16.96±0.76)°和(41.64±0.81)°，均处于安全范围；15例患者术后1周与末次随访的髋关节中心边缘角、髋臼角比较差异均无显著性意义(P > 0.05)；④结果表明，对于Paprosky Ⅲ型髋臼骨缺损患者，采用自体髂骨块联合钛板重建髋臼环能够恢复髋关节解剖结构，为假体提供坚强的初始固定，可以取得良好的早期临床疗效。

https://orcid.org/0000-0003-0551-0686 (薛亚东) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髋关节翻修, 自体髂骨块, 钛板, 骨缺损, 髋臼重建, 异体骨颗粒, 髋臼环

Abstract: BACKGROUND: In recent years, new progress has been made in the treatment of Paprosky III acetabular defects at home and abroad. Commonly used reconstruction methods include tantalum metal pads, acetabular strengthening cups-reinforcing rings, cemented acetabular prostheses, reconstruction steel plates, and titanium metal mesh.  
OBJECTIVE: To investigate the clinical efficacy of using autogenous iliac bone blocks in combination with titanium plate to reconstruct Paprosky III type of acetabular defects in revision total hip arthroplasty.
METHODS:  Totally 15 patients with severe acetabular defects reconstruction utilizing autogenous iliac bone blocks combined with titanium plates, including 9 men and 6 women, with age of 47-78 years, were selected from June 2012 to August 2020 from First Affiliated Hospital of Bengbu Medical College. Clinical manifestations and postoperative X-ray characteristics of the patients were observed. The Harris hip score and visual analogue scale score prior to operation and at the last follow-up visit were evaluated. The anteverted angle and abduction angle of the postoperative acetabular cup were recorded. The changes of center-edge angle of hip joint and acetabular angle were measured 1 week after surgery and at the last follow-up. The incidence of postoperative complications was observed. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College.  
RESULTS AND CONCLUSION: (1) All of the 15 patients were successfully operated and followed up for 12 to 60 months. Among them, one case had symptoms of lateral femoral cutaneous nerve injury, but no plate fracture, osteolysis, infection, or periprosthetic fracture occurred. (2) Harris hip score and visual analogue scale score were significantly improved during the last follow-up in 15 patients (P < 0.05). (3) The anteversion angle and abduction angle of the acetabular cup were (16.96±0.76)° and (41.64±0.81)°, respectively, both of which were within the safety range in 15 patients. One week post surgery and at the last follow-up, the center-edge angle and acetabular angle were not significantly different in 15 patients (P > 0.05). (4) It is concluded that for patients with Paprosky III acetabular bone defects, acetabular ring reconstructed by autogenous iliac bone and allogeneic grain bone combined with titanium plate can restore anatomic structure of the hip joint, which provides a strong initial fixation for the prosthesis, finally obtaining satisfactory clinical outcomes.

Key words: revision of hip joint, autogenous iliac bone mass, titanium plate, bone defect, acetabulum reconstruction, allogeneic bone granules, acetabulum ring

中图分类号: