【摘要】：目的探討應用大號生物型臼杯(Jumbo臼杯)行髖關節(jié)翻修術后髖關節(jié)旋轉中心(hip center of rotation,COR)和股骨偏心距的變化。方法回顧性分析2010年1月—2015年5月應用Jumbo臼杯行髖關節(jié)翻修術的23例患者臨床資料,其中8例聯(lián)合顆粒骨植骨,10例聯(lián)合顆粒骨植骨并結構性植骨。男10例,女13例;年齡51~77歲,平均65.4歲。初次人工全髖關節(jié)置換術至翻修術間隔1~24年,平均8.57年。髖關節(jié)翻修原因:無菌性松動21例,假體周圍感染2例。患者Harris評分為(43.04±5.05)分,疼痛視覺模擬評分(VAS)為(5.70±0.97)分。骨缺損根據Paprosky分型標準,Ⅰ型5例,ⅡA型5例,ⅡB型3例,ⅡC型6例,ⅢA型4例。雙髖X線片測量示,健側股骨偏心距為(40.65±4.09)mm,患側為(44.04±5.08)mm,比較差異有統(tǒng)計學意義(t=4.098,P=0.000);10例(43.48%)股骨偏心距重建,13例(56.52%)未重建;10例(43.48%)COR重建,11例(47.83%)COR上移,2例(8.69%)COR下移。結果術后切口均Ⅰ期愈合,無感染、血管損傷、下肢深靜脈血栓形成、關節(jié)脫位、假體周圍骨折等并發(fā)癥發(fā)生�；颊呔@隨訪,隨訪時間12~76個月,平均22.48個月。術后1年Harris評分為(82.09±4.53)分,VAS評分為(0.74±0.62)分,與術前比較差異均有統(tǒng)計學意義(t=37.831,P=0.000;t=22.318,P=0.000)。X線片復查示,翻修術后1年患側股骨偏心距為(43.87±3.57)mm,與術前比較差異無統(tǒng)計學意義(t=0.250,P=0.805),與健側比較差異有統(tǒng)計學意義(t=5.591,P=0.000)。翻修術后患側股骨偏心距重建16例(69.57%),未重建7例(30.43%);15例(65.22%)COR重建,8例(34.78%)COR上移。結論單純應用Jumbo臼杯行髖關節(jié)翻修術可能導致COR上移和股骨偏心距增加。合理安放Jumbo臼杯以及正確處理髖臼骨缺損,能夠最大限度恢復COR和股骨偏心距,獲得良好近期療效,假體穩(wěn)定性可。
[Abstract]:Objective to investigate the changes of hip rotation center (hip center of rotation,COR) and femoral eccentricity after hip revision with large biological acetabular cup (Jumbo cup). Methods from January 2010 to May 2015, the clinical data of 23 patients undergoing revision of hip joint with Jumbo cup were retrospectively analyzed. Among them, 8 cases were combined with granular bone graft, 10 cases were combined with granular bone graft and structural bone graft. There were 10 males and 13 females, aged 51 to 77 years, with an average age of 65.4 years. The interval between primary total hip replacement and revision was 1 ~ 24 years (mean 8.57 years). The causes of hip revision were aseptic loosening in 21 cases and periprosthetic infection in 2 cases. The Harris score was (43.04 鹵5.05) and the pain visual analogue score (VAS) was (5.70 鹵0.97). According to Paprosky classification criteria, there were 5 cases of type 鈪，

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