来源：304关节学术

译者：张蔷

整理：骨科在线

Stigbrand H等发表于《J Arthroplasty》杂志的一篇2-16年随访研究显示，打压植骨联合加压钛金属外杯用于髋翻修时处理髋臼侧骨缺损情况可获得优良的效果。

目前髋翻修时处理髋臼侧骨缺损是一件极有挑战性的工作，原则上讲有四种基本方法：髋关节中心上移并应用大臼，结构性植骨，颗粒性植骨，骨小梁结构的金属垫块。AAOS将髋翻修术中髋臼侧骨缺损分为四类：节段性骨缺损（Ⅰ类），腔隙性骨缺损（Ⅱ类），腔隙性与节段性混合骨缺损（Ⅲ类），骨盆不连续（Ⅳ类）。打压植骨技术的理念中包含许多重要的细节，其中影响骨愈合的两条先决条件即为植骨稳定性与植骨加压情况。下面介绍一种使用薄的多孔钛金属外杯进一步加压和稳定髋臼侧植骨的方法。

模型示意图：节段性混合腔隙性骨缺损（AAOS分型定义）

研究人员回顾了过去7年内170例髋臼翻修中应用打压植骨联合多孔钛金属外杯加压植骨块的病例。内容包括临床评分和影像学。3人失随访。33人过世，但将其资料进行了收集。这170人中，74例有腔隙性髋臼骨缺损，93例有腔隙性混合节段性骨缺损，3人有骨盆不连续。随访时评估项目包括植骨长入情况以及髋关节旋转中心的变化。

应用0.8mm厚的多孔预弯金属钛板在髋臼外覆盖节段性骨缺损

专用髋臼植骨打器：外表面多轨形态加强并稳定植骨床，引流孔为打压时引流植骨块内的骨髓脂肪

A：0.8mm厚纯钛外杯

B：1.0mm厚 纯钛外杯

打压植骨后用4-7枚短钛钉将外杯固定于植骨床之上，再用骨水泥将聚乙烯外杯粘入

植骨片打压入钛板内，修复了节段性髋臼骨缺损，再植入钛金属外杯加压并稳定植骨床

应用此方法治疗AAOS Ⅲ型髋臼侧骨缺损后6年影像学表现

骨水泥突破外杯空隙混合植骨片加强固定

结果显示，共有5例（3%）因机械性松动接受再翻修手术。1例被诊断为松动，但无症状而没有进行再翻修。3例复发性脱位，2例关节感染和1例技术性失误，均接受了再次翻修手术。如果以再次手术作为生存终点，10年随访时的生存率为92%。髋关节评分从10.8（术前）提升至16.4（随访）。影像学评估结果良好。

Kaplan-Meier生存曲线

原文摘要：

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup.

Background:

Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell.

Methods:

We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated.

Results:

Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent.

Conclusion:

IBG combined with the compressing shell results in excellent results for this challenging condition.

文献出处：

Stigbrand H, Gustafsson O, Ullmark G. A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New AcetabularImplant Combined With Impacted Bone Allografts and a Cemented Cup. J Arthroplasty. 2018 Mar;33(3):815-822. doi: 10.1016/j.arth.2017.10.006. Epub 2017 Oct 10.