伴髋臼骨缺损的THA术中植骨的应用及疗效观察

发布时间：2018-02-26 00:06

  本文关键词： 髋关节置换 髋臼骨缺损 Paprosky分型 骨移植　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:世界范围内接受髋置换的患者人数逐年增长,合并骨缺损的髋臼重建已是骨科医生常见的难题。修复髋臼的方式有许多,骨移植作为一种经典的髋臼重建方式,随患者条件差异而有不同运用,且疗效及预后各不相同,争议较多。目的:通过对20例行全髋关节置换手术、并通过颗粒植骨或结构植骨方式修复髋臼侧骨缺损的患者进行定期随访,对治疗效果进行分析,讨论髋置换术中髋臼侧骨缺损处理应用骨移植技术的疗效及选择。方法:选取我院自2013年11月至2016年12月行全髋关节置换手术,并通过植骨修复髋臼骨缺损的病例20例20髋,包括3例髋臼发育不良并髋关节病、3例股骨头缺血坏死、14例髋关节置换术后假体松动,其中按Paprosky分型有Ⅱb型11髋、Ⅱc型1髋、Ⅲa型4髋、Ⅲb型4髋,记录患髋Harris评分以及VAS评分变化情况,拍摄骨盆平片评价移植骨情况及假体移位或松动程度。对骨缺损类型、植骨方式、功能评分差异及术后相关并发症进行评估。结果:共18例患者获得随访,平均随访时间18个月(4-40个月),Harris评分由术前37.9±9.8(21-57分)分提高到术后86.4±5.9(75-93分)分,优良率达80.0%。1例术后2个月检查发现髋臼假体松动后失访,1例术后2个月发生髋关节脱位,考虑假体内陷,再次行髋关节翻修术,1例术后发生脱位并行复位术,延长卧床保守治疗后未再次脱位,1例术后出现盆腔血肿,考虑髋臼固定螺钉损伤骨盆血管所致。除再次翻修病例外,余患者术后随访骨盆平片均未见假体松动现象与移植骨吸收现象。结论:结构植骨与颗粒骨打压植骨均为全髋关节置换术中重建髋臼的有效方法,根据患者条件选择适宜的修复方案,短期效果理想。
[Abstract]:Background: the number of patients undergoing hip replacement is increasing year by year. The reconstruction of acetabular with bone defect has become a common problem for orthopedic doctors. There are many ways to repair acetabular. Bone graft is a classical method of acetabular reconstruction. The effect and prognosis are different and controversial. Objective: 20 cases of total hip replacement were performed. The patients with acetabular lateral bone defect repaired by granular or structural bone grafting were followed up regularly and the therapeutic effect was analyzed. To discuss the effect and choice of bone graft in the management of acetabular bone defect in hip replacement. Methods: 20 cases (20 hips) with acetabular bone defect were treated with total hip replacement from November 2013 to December 2016 in our hospital. There were 3 cases of acetabular dysplasia, 3 cases of avascular necrosis of femoral head and 14 cases of prosthesis loosening after hip replacement. According to Paprosky classification, there were 11 hips of type 鈪，

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