【摘要】：目的:評估在全髖關(guān)節(jié)翻修術(shù)中應(yīng)用鉭金屬Jumbo杯重建嚴重Gross型髖臼骨缺損的早期臨床療效。方法:從2012年10月至2016年5月在山西醫(yī)科大學第二醫(yī)院關(guān)節(jié)外科就診的Gross III型和Gross IV型髖臼骨缺損患者32例。依據(jù)手術(shù)方法的不同分為兩組,觀察組:17例患者采用鉭金屬Jmubo杯行翻修手術(shù),對照組:15例患者采用普通生物型髖臼杯聯(lián)合結(jié)構(gòu)植骨行翻修手術(shù)。觀察比較兩組髖關(guān)節(jié)Harris評分、髖臼外展角變化、髖臼旋轉(zhuǎn)中心(水平及垂直方向位移)雙下肢長度變化等情況及并發(fā)癥。結(jié)果:功能評價:所有患者均得到了早期隨訪。隨訪時間(29±14)月(13~53月)。觀察組和對照組術(shù)后Harris評分較術(shù)前均得到明顯增加,具有統(tǒng)計學差異(P0.05),兩組在術(shù)前Harris評分無統(tǒng)計學差異(P0.05),觀察組的術(shù)后Harris評分明顯高于對照組(P0.05)。影像學評價:患者在術(shù)后48小時拔出引流管后行X線檢查,并與術(shù)后末次隨訪對比,相比于術(shù)后48小時髖臼假體位置,末次隨訪時對照組在外展角變化,水平和垂直距離位移均大于觀察組(P0.05)。術(shù)后觀察組和對照組雙下肢長度差值絕對值的減少較術(shù)前分別得到改善了(P0.05)。術(shù)前兩組雙下肢的差值無統(tǒng)計學意義(P0.05),術(shù)后觀察組的雙下肢長度差值的減少程度明顯高于對照組(P0.05)。術(shù)后觀察組的髖臼旋轉(zhuǎn)中心位置(水平和垂直位移)與術(shù)前相比得到明顯改變(P0.05),術(shù)后對照組的髖臼旋轉(zhuǎn)中心位置(水平和垂直位移)與術(shù)前相比得到明顯改變(P0.05),術(shù)前兩組髖臼旋轉(zhuǎn)中心差異不明顯(P0.05),術(shù)后兩組髖臼中心在水平位置的差異不明顯(P0.05),在垂直位置上存在差異(P0.05),由此可見兩者基本可重建髖臼中心,獲得牢固初始穩(wěn)定。觀察組在末次隨訪時所有的鉭金屬Jumbo杯與骨面接觸緊密,骨缺損區(qū)被完全填充,植骨整合替代情況滿意,所有患者均無大于2mm以上的透亮線,髖臼旋轉(zhuǎn)中心水平位移和垂直位移均小于4mm,外展角也都小于4°。而對照組則有2例患者的外展角變化大于4°,1例水平位移大于7mm,可診斷為假體松動,因患者無任何不適,不做進一步處理。另外隨訪中我們發(fā)現(xiàn)有3例患者髖臼側(cè)分別有一處或兩處小于2mm透亮線,隨著時間的延長,提示假體移位和松動概率會更大,遠期的生存率令人擔憂。并發(fā)癥:所有隨訪病人至末次隨訪時未曾有假體周圍骨折、神經(jīng)損傷及感染等并發(fā)癥出現(xiàn)。觀察組只有1例患者于術(shù)后5天在床上翻身時患側(cè)內(nèi)旋角度過大而發(fā)生髖關(guān)節(jié)后脫位,在麻醉下行閉合復(fù)位,術(shù)后制動皮膚牽引4周,至末次隨訪時沒有再發(fā)生脫位。對照組分別有1例患者出現(xiàn)傷口愈合延遲和2例下肢深靜脈血栓形成,經(jīng)過治療后痊愈。結(jié)論:鉭金屬Jumbo杯相比傳統(tǒng)手術(shù)減少植骨量,最大限度的恢復(fù)髖臼旋轉(zhuǎn)中心,具有良好骨長入能力,既可保證假體的初始穩(wěn)定,又有滿意的遠期生存前景,在重度髖臼骨缺損髖關(guān)節(jié)翻修術(shù)相比普通生物型髖臼杯聯(lián)合結(jié)構(gòu)植骨術(shù)可以取得顯著的臨床療效。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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