打压植骨结合金属网重建全髋关节翻修术中髋臼侧严重骨缺损.docx

打压植骨结合金属网重建全髋关节翻修术中髋臼侧严重骨缺损【摘要】探讨在全髋关节翻修术中使用打压植骨技术结合金属网重建严重髋臼骨缺损的方法和效果。［方法］2001年12月至2006年1月应用打压植骨技术结合金属网重建严重髋臼侧骨缺损的患者共有21例21髋，男6例，女15例；翻修时平均年龄为岁。采用美国骨科医师协会分型，本组患者骨缺损均为AAOSⅢ型。采用金属网将非包容性骨缺损转变为包容性骨缺损，然后采用7~10mm的深低温冷冻骨颗粒，使用打压植骨技术恢复骨量，重建髋关节的正常解剖形态，使用骨水泥将聚乙烯臼杯固定于理想的生物力学位置。拍摄术后3d、3个月、1年及每年随访时的双髋正位片，以泪滴为参照，观察聚乙烯臼杯位置的变化及骨水泥层透亮线的变化,并进行Harris髋关节评分比较。［结果］平均随访年，Harris评分从术前平均分提高到术后分,未发现臼杯松动病例。术后1例脱位，1例有坐骨神经受损症状。［结论］在髋关节翻修术中采用打压植骨技术并结合应用金属网的方法能较好地重建髋臼侧严重骨缺损，恢复骨量，辅助髋臼安放在理想的生物力学位置，并能提供良好的早期稳定性。【关键词】关节成形术置换髋打压植骨翻修术金属网Abstract：［Objective］Toinvestigatethemethodandeffeciencyofmanagementmassiveacetabularbonedefectwithimpactionbonegraftingplusmeshinrevisiontotalhiparthroplasty［Method］Twentyonepatients21hipswithmassiveacetabularbonedefectweretreatedwithimpactionbonegraftingplusmeshduringDec2001toJan2006,including6menand15women,theaverageagewereyearsattherevisionoperation.TheacetabulardefectsofthepatientsinthisstudygroupweretypeIIIaccordingtotheAmericanAcademyofOrthopaedicSurgeonsclassificationfirstthecombineddefectwastransformedintocavitarydefectwithmetalmesh,thenthecontainedacetabulumwastightlypackedwithdeepfrozenmorselizedcancellousallograftchips,theanatomyofthehipwasreconstructedandthecupwasinsertedafterpressurizingthecementdirectlyontotheAPviewofthehipat3days,3months,1yearandyearlyaftertheoperationwereobtained,cupmigrationaccordingtotheteardropandradiolucentlinewereevaluated，atthesametimetheHarrishipscorewerealsoevaluated.［Result］Themeanfollowuptimewasyears，themeanHarrishipscoreimprovedfrompointspreoperativelytopointsatthefinalevaluation,nocupmigrationwerefound,exceptforonedislocationandonesciaticnerveinjury,aswellaslostfollowupforonehip.［Conclusion］Impactionbonegraftingplusmeshisaneffectiveapproachtotreatmassiveacetabularbonedefectinrevisiontotalhiparthroplasty,itcanrestorebonestockandhelpthecuptobeplacedtotheanatomicposition,aswellasprovideexecellentprothesisstability.Keywords:arthroplasty,replacement,hip;impactionbonegrafting;revision;mesh髋臼侧假体松动和骨溶解是人工全髋关节翻修术中的常见原因，手术时如何处理假体周围的