钽金属Jumbo杯重建严重Gross型髋臼骨缺损的早期临床疗效观察
发布时间：2018-09-05 21:04
【摘要】：目的:评估在全髋关节翻修术中应用钽金属Jumbo杯重建严重Gross型髋臼骨缺损的早期临床疗效。方法:从2012年10月至2016年5月在山西医科大学第二医院关节外科就诊的Gross III型和Gross IV型髋臼骨缺损患者32例。依据手术方法的不同分为两组,观察组:17例患者采用钽金属Jmubo杯行翻修手术,对照组:15例患者采用普通生物型髋臼杯联合结构植骨行翻修手术。观察比较两组髋关节Harris评分、髋臼外展角变化、髋臼旋转中心(水平及垂直方向位移)双下肢长度变化等情况及并发症。结果:功能评价:所有患者均得到了早期随访。随访时间(29±14)月(13~53月)。观察组和对照组术后Harris评分较术前均得到明显增加,具有统计学差异(P0.05),两组在术前Harris评分无统计学差异(P0.05),观察组的术后Harris评分明显高于对照组(P0.05)。影像学评价:患者在术后48小时拔出引流管后行X线检查,并与术后末次随访对比,相比于术后48小时髋臼假体位置,末次随访时对照组在外展角变化,水平和垂直距离位移均大于观察组(P0.05)。术后观察组和对照组双下肢长度差值绝对值的减少较术前分别得到改善了(P0.05)。术前两组双下肢的差值无统计学意义(P0.05),术后观察组的双下肢长度差值的减少程度明显高于对照组(P0.05)。术后观察组的髋臼旋转中心位置(水平和垂直位移)与术前相比得到明显改变(P0.05),术后对照组的髋臼旋转中心位置(水平和垂直位移)与术前相比得到明显改变(P0.05),术前两组髋臼旋转中心差异不明显(P0.05),术后两组髋臼中心在水平位置的差异不明显(P0.05),在垂直位置上存在差异(P0.05),由此可见两者基本可重建髋臼中心,获得牢固初始稳定。观察组在末次随访时所有的钽金属Jumbo杯与骨面接触紧密,骨缺损区被完全填充,植骨整合替代情况满意,所有患者均无大于2mm以上的透亮线,髋臼旋转中心水平位移和垂直位移均小于4mm,外展角也都小于4°。而对照组则有2例患者的外展角变化大于4°,1例水平位移大于7mm,可诊断为假体松动,因患者无任何不适,不做进一步处理。另外随访中我们发现有3例患者髋臼侧分别有一处或两处小于2mm透亮线,随着时间的延长,提示假体移位和松动概率会更大,远期的生存率令人担忧。并发症:所有随访病人至末次随访时未曾有假体周围骨折、神经损伤及感染等并发症出现。观察组只有1例患者于术后5天在床上翻身时患侧内旋角度过大而发生髋关节后脱位,在麻醉下行闭合复位,术后制动皮肤牵引4周,至末次随访时没有再发生脱位。对照组分别有1例患者出现伤口愈合延迟和2例下肢深静脉血栓形成,经过治疗后痊愈。结论:钽金属Jumbo杯相比传统手术减少植骨量,最大限度的恢复髋臼旋转中心,具有良好骨长入能力,既可保证假体的初始稳定,又有满意的远期生存前景,在重度髋臼骨缺损髋关节翻修术相比普通生物型髋臼杯联合结构植骨术可以取得显著的临床疗效。
[Abstract]:Objective: To evaluate the early clinical effect of tantalum Jumbo cup in the reconstruction of gross acetabular bone defect during total hip arthroplasty. Methods: From October 2012 to May 2016, 32 patients with gross III and gross IV acetabular bone defects were treated in the Department of Arthroplasty, Second Hospital of Shanxi Medical University. Group A, Group B: 17 patients underwent revision surgery with tantalum Jmubo cup. Group B: 15 patients underwent revision surgery with common bio-acetabular cup combined with bone graft. The Harris score of the acetabulum, the abduction angle of the acetabulum, the length of the acetabulum rotation center (horizontal and vertical displacement) and the complications were observed and compared between the two groups. Results: Functional evaluation: All patients were followed up early. The follow-up time was (29 + 14) months (13 - 53 months). The postoperative Harris score of the observation group and the control group was significantly higher than that of the preoperative (P 0.05). There was no significant difference in preoperative Harris score between the two groups (P 0.05). The postoperative Harris score of the observation group was significantly higher than that of the control group (P 0.05). Imaging evaluation: X-ray examination was performed 48 hours after the drainage tube was pulled out, and compared with the last follow-up. Compared with the position of acetabular prosthesis 48 hours after the operation, the change of abduction angle in the control group at the last follow-up was greater than that in the observation group (P 0.05). There was no significant difference between the two groups before operation (P 0.05). The reduction of the length difference between the two groups was significantly higher than that of the control group (P 0.05). The position of acetabular rotation center (horizontal and vertical displacement) in the observation group was significantly changed after operation (P 0.05). The acetabular rotation center position (horizontal and vertical displacement) of the control group was significantly changed (P 0.05) compared with that of the preoperative group, and there was no significant difference between the two groups (P 0.05). The acetabular rotation center of the two groups had no significant difference in horizontal position (P 0.05), and there was a difference in vertical position (P 0.05). At the last follow-up, all the Tantalum Jumbo cups contacted tightly with the bone surface, the bone defect area was filled completely, and the bone graft was replaced satisfactorily. There was no bright line greater than 2 mm in all the patients. The horizontal and vertical displacement of the acetabular rotation center were less than 4 mm, and the abduction angle was less than 4 degrees. In the control group, the abduction angle of 2 patients was greater than 4 degrees, and the horizontal displacement of 1 patient was greater than 7 mm, which could be diagnosed as prosthesis loosening without any discomfort. Complications: There were no periprosthetic fractures, nerve injury, infection or other complications at the end of the follow-up. Only one patient in the observation group had posterior dislocation of the hip caused by excessive lateral rotation when he rolled over on the bed 5 days after surgery. Closed reduction was performed under anesthesia. One patient in the control group had delayed wound healing and two patients had deep vein thrombosis of the lower extremity, which were cured after treatment. Conclusion: Tantalum Jumbo cup can reduce the amount of bone graft and restore the rotational center of the acetabulum to the maximum extent. It has good bone ingrowth energy. Force can not only ensure the initial stability of the prosthesis, but also satisfy the long-term survival prospects. In severe acetabular bone defects, revision hip arthroplasty can achieve a significant clinical effect compared with conventional biological acetabular cup combined structure bone grafting.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
本文编号：2225458
[Abstract]:Objective: To evaluate the early clinical effect of tantalum Jumbo cup in the reconstruction of gross acetabular bone defect during total hip arthroplasty. Methods: From October 2012 to May 2016, 32 patients with gross III and gross IV acetabular bone defects were treated in the Department of Arthroplasty, Second Hospital of Shanxi Medical University. Group A, Group B: 17 patients underwent revision surgery with tantalum Jmubo cup. Group B: 15 patients underwent revision surgery with common bio-acetabular cup combined with bone graft. The Harris score of the acetabulum, the abduction angle of the acetabulum, the length of the acetabulum rotation center (horizontal and vertical displacement) and the complications were observed and compared between the two groups. Results: Functional evaluation: All patients were followed up early. The follow-up time was (29 + 14) months (13 - 53 months). The postoperative Harris score of the observation group and the control group was significantly higher than that of the preoperative (P 0.05). There was no significant difference in preoperative Harris score between the two groups (P 0.05). The postoperative Harris score of the observation group was significantly higher than that of the control group (P 0.05). Imaging evaluation: X-ray examination was performed 48 hours after the drainage tube was pulled out, and compared with the last follow-up. Compared with the position of acetabular prosthesis 48 hours after the operation, the change of abduction angle in the control group at the last follow-up was greater than that in the observation group (P 0.05). There was no significant difference between the two groups before operation (P 0.05). The reduction of the length difference between the two groups was significantly higher than that of the control group (P 0.05). The position of acetabular rotation center (horizontal and vertical displacement) in the observation group was significantly changed after operation (P 0.05). The acetabular rotation center position (horizontal and vertical displacement) of the control group was significantly changed (P 0.05) compared with that of the preoperative group, and there was no significant difference between the two groups (P 0.05). The acetabular rotation center of the two groups had no significant difference in horizontal position (P 0.05), and there was a difference in vertical position (P 0.05). At the last follow-up, all the Tantalum Jumbo cups contacted tightly with the bone surface, the bone defect area was filled completely, and the bone graft was replaced satisfactorily. There was no bright line greater than 2 mm in all the patients. The horizontal and vertical displacement of the acetabular rotation center were less than 4 mm, and the abduction angle was less than 4 degrees. In the control group, the abduction angle of 2 patients was greater than 4 degrees, and the horizontal displacement of 1 patient was greater than 7 mm, which could be diagnosed as prosthesis loosening without any discomfort. Complications: There were no periprosthetic fractures, nerve injury, infection or other complications at the end of the follow-up. Only one patient in the observation group had posterior dislocation of the hip caused by excessive lateral rotation when he rolled over on the bed 5 days after surgery. Closed reduction was performed under anesthesia. One patient in the control group had delayed wound healing and two patients had deep vein thrombosis of the lower extremity, which were cured after treatment. Conclusion: Tantalum Jumbo cup can reduce the amount of bone graft and restore the rotational center of the acetabulum to the maximum extent. It has good bone ingrowth energy. Force can not only ensure the initial stability of the prosthesis, but also satisfy the long-term survival prospects. In severe acetabular bone defects, revision hip arthroplasty can achieve a significant clinical effect compared with conventional biological acetabular cup combined structure bone grafting.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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