植骨技术在髋关节发育不良患者全髋关节置换术中的应用

发布时间：2018-06-20 22:45

  本文选题：髋关节发育不良 + 全髋关节置换术　； 参考：《山东中医药大学》2015年硕士论文

【摘要】：背景：髋关节发育不良(Developmental Dysplasia of the Hip, DDH)是一种临床常见的成人髋关节疾病,临床现阶段大多采用全髋关节置换术(Total Hip Arthroplasty, THA)作为该病的最终手术治疗手段。髋关节发育不良的患者因其患侧髋臼不同程度的骨缺损,往往造成假体臼杯覆盖率不足。应用术中截下的患者自身股骨头或自体髂骨作为植骨来源重建缺损髋臼,可获得满意的假体覆盖率及稳定性,从而延长假体寿命,提高患者满意度。目的：本研究目的在于探究植骨技术(结构性植骨、颗粒植骨)在髋关节发育不良全髋关节置换术中的应用。通过手术前后影像学改变及跟踪观察、术前术后髋关节功能评分等,对术后效果进行研究与验证,判断植骨技术重建髋臼对行全髋关节置换术的髋关节发育不良病人的手术短期疗效。方法：对2013年3月至2014年10月山东中医药大学第一附属医院(山东省中医院)关节骨科收治的38例髋关节发育不良患者行结构性植骨或颗粒植骨重建髋臼全髋关节置换术。成功随访35例40髋,Crowe分型均为Ⅱ、Ⅲ和Ⅳ型；其中Ⅱ型髋21例,Ⅲ型髋13例,Ⅳ型髋6例,平均随访时间为1年。术前做常规影像学检查,对髋臼的缺损程度、髋臼附近骨的质量及股骨头情况进行术前评估。术中使用小号髋臼锉对植骨床骨面进行处理,取截下的股骨头或患者自身髂骨作为植骨来源重建髋臼。随访病人术前做Harris评分,术后半年做随访评分,所有数据进行统计学检验,对手术效果进行综合判断。结果：除1例单髋术后半年因脱位翻修,2例患者因各种原因未能随访成功。成功随访35例40髋,均未出现假体松动、植骨吸收松动。影像学改变可见植骨与宿主骨融合,接触面模糊消失,骨小梁重建；未见假体位移及明显植骨吸收。Harris评分术前平均44.99分,术后半年平均Harris评分89.53分,明显高于术前(PS≤0.01)。以Harris评分反应术后效果,优良率达100%。结论：术后随访病人髋关节正位X线片可见植骨部分与宿主骨均融合,接触面随时间逐渐模糊甚至消失,且病人术后Harris评分相比术前明显提高,患者髋关节功能显著改善,提高了患者的生活质量。说明人工全髋关节置换术治疗髋关节发育不良手术过程中采用植骨技术处理髋臼骨缺损对患者术后髋关节的功能短期内具有安全有效的意义。
[Abstract]:Background: developmental dysplasia of the hip (DDH) is a common adult hip disease. Patients with dysplasia of hip joint often have insufficient coverage of acetabular cup because of different degree of bone defect in the affected acetabulum. Using the femoral head or autogenous iliac bone as the source of bone graft to reconstruct the acetabular defect, satisfactory prosthesis coverage and stability can be obtained, thus prolonging the life span of the prosthesis and increasing the patient's satisfaction. Objective: to explore the application of bone grafting (structural bone grafting, granular bone grafting) in total hip replacement with dysplasia of hip. The effect of the operation was studied and verified by imaging changes and follow-up observation before and after operation and the score of hip joint function before and after operation. Objective: to evaluate the short-term effect of acetabular reconstruction with bone grafting in patients with hip dysplasia undergoing total hip replacement. Methods: from March 2013 to October 2014, 38 patients with hip dysplasia were treated in the Department of Joint Orthopedics, the first affiliated Hospital of Shandong University of traditional Chinese Medicine (Shandong traditional Chinese Medicine Hospital). All 35 cases (40 hips) were classified as type 鈪，

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