本文關(guān)鍵詞： 髖關(guān)節(jié)置換 髖臼骨缺損 Paprosky分型 骨移植　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景:世界范圍內(nèi)接受髖置換的患者人數(shù)逐年增長(zhǎng),合并骨缺損的髖臼重建已是骨科醫(yī)生常見(jiàn)的難題。修復(fù)髖臼的方式有許多,骨移植作為一種經(jīng)典的髖臼重建方式,隨患者條件差異而有不同運(yùn)用,且療效及預(yù)后各不相同,爭(zhēng)議較多。目的:通過(guò)對(duì)20例行全髖關(guān)節(jié)置換手術(shù)、并通過(guò)顆粒植骨或結(jié)構(gòu)植骨方式修復(fù)髖臼側(cè)骨缺損的患者進(jìn)行定期隨訪(fǎng),對(duì)治療效果進(jìn)行分析,討論髖置換術(shù)中髖臼側(cè)骨缺損處理應(yīng)用骨移植技術(shù)的療效及選擇。方法:選取我院自2013年11月至2016年12月行全髖關(guān)節(jié)置換手術(shù),并通過(guò)植骨修復(fù)髖臼骨缺損的病例20例20髖,包括3例髖臼發(fā)育不良并髖關(guān)節(jié)病、3例股骨頭缺血壞死、14例髖關(guān)節(jié)置換術(shù)后假體松動(dòng),其中按Paprosky分型有Ⅱb型11髖、Ⅱc型1髖、Ⅲa型4髖、Ⅲb型4髖,記錄患髖Harris評(píng)分以及VAS評(píng)分變化情況,拍攝骨盆平片評(píng)價(jià)移植骨情況及假體移位或松動(dòng)程度。對(duì)骨缺損類(lèi)型、植骨方式、功能評(píng)分差異及術(shù)后相關(guān)并發(fā)癥進(jìn)行評(píng)估。結(jié)果:共18例患者獲得隨訪(fǎng),平均隨訪(fǎng)時(shí)間18個(gè)月(4-40個(gè)月),Harris評(píng)分由術(shù)前37.9±9.8(21-57分)分提高到術(shù)后86.4±5.9(75-93分)分,優(yōu)良率達(dá)80.0%。1例術(shù)后2個(gè)月檢查發(fā)現(xiàn)髖臼假體松動(dòng)后失訪(fǎng),1例術(shù)后2個(gè)月發(fā)生髖關(guān)節(jié)脫位,考慮假體內(nèi)陷,再次行髖關(guān)節(jié)翻修術(shù),1例術(shù)后發(fā)生脫位并行復(fù)位術(shù),延長(zhǎng)臥床保守治療后未再次脫位,1例術(shù)后出現(xiàn)盆腔血腫,考慮髖臼固定螺釘損傷骨盆血管所致。除再次翻修病例外,余患者術(shù)后隨訪(fǎng)骨盆平片均未見(jiàn)假體松動(dòng)現(xiàn)象與移植骨吸收現(xiàn)象。結(jié)論:結(jié)構(gòu)植骨與顆粒骨打壓植骨均為全髖關(guān)節(jié)置換術(shù)中重建髖臼的有效方法,根據(jù)患者條件選擇適宜的修復(fù)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，

本文編號(hào)：1535698