非骨水泥全髋关节髋臼骨溶解的特点及治疗对策
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Characteristics of the pelvis osteolysis and its treatment in cementless total hip arthroplasty
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    目的:分析非骨水泥全髋关节置换术后髋臼骨溶解发生的特点,对照术前X线评估与术中发现,以利寻求更精确的骨溶解评估方法-方法:对6例非骨水泥全髋关节髋臼骨溶解及松动患者进行翻修手术-通过对术前X线的评估,初步了解非骨水泥髋臼骨溶解的部位和范围,并对由骨溶解造成的髋臼骨缺损进行Paprosky分型-术中明确骨缺损的真正大小和范围-并与术前放射学评估对比-结果:术前1例X线无髋臼骨缺损,术中发现为Paprosky Ⅰ型缺损,术前3例Ⅰ型缺损实际为Ⅱ型缺损,2例Ⅱ型缺损实为Ⅲ型缺损-3例Ⅱ型缺损进行了颗粒打压植骨非骨水泥臼固定,2例Ⅲ型缺损进行了颗粒打压植骨加强杯骨水泥臼固定,另外1例术前放射学评估无骨缺损的病例因聚乙烯臼磨损,在原来的金属臼内重新固定了1个骨水泥臼-6例患者经术后1年随访,髋关节功能恢复良好,Harris评分平均为87分-结论:非骨水泥全髋关节术后,髋臼周围骨溶解,术前普通的放射学检查不能充分了解骨缺损的实际大小和范围,应该采用更精确的放射学检查-

    Abstract:

    Objective:To analyze the specific features of the pelvis osteolysis in cementless total hip arthroplasty and observe the differences between the pre-operative radiological evaluation and the true situation during operation. Methods:Six cementless hips of acetabulum loosening were revised in 2005. The osteolysis and defects were classified according to the method of Paprosky. Results:During the operations 1 case was type Ⅰ defects according to Paprosky which was evaluated non-osteolysis rediographically pre-operation. 3 cases were type Ⅱ defects which were diagnosed type Ⅰ pre-operation,and 2 cases of Ⅲ were diagnosed type Ⅱ pre-operation. 3 hips of type Ⅱ were revised with impacted bone graft and implantation of non-cement cups. 2 hips of type Ⅲ were revised with impacted bone graft and fixed with roof reinforced rings and cemented cups. 1 hip of type Ⅰ was revised with the fixation of a cemented cup within the original metal shell. All the patients were followed for 1 year radiographically and functionally. Conclusion:After cementless total hip arthroplasty,the osteolysis and bone defects in the acetabulum cannot be evaluated accurate radiography. More accurate methods should be used before operation,such as CT.

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李民进,刘 锋.非骨水泥全髋关节髋臼骨溶解的特点及治疗对策[J].南京医科大学学报(自然科学版),2007,(9):1016-1019

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  • 收稿日期:2007-03-29
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