采用超大生物型臼杯行髖關節翻修術的療效觀察_《中國修復重建外科雜志》

作者：

方遠 , 孫俊英 , 查國春 , 王濤 , 魏召勸 , 董圣杰

蘇州大學附屬第一醫院骨科（江蘇蘇州，215006）;

關鍵詞：

超大生物型臼杯髖關節翻修術假體無菌性松動股骨假體周圍骨折

DOI：

10.7507/1002-1892.20130312

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目的探討采用超大生物型臼杯行髖關節翻修術的臨床療效。方法回顧分析1996年5月－2011年5月，采用超大生物型臼杯行髖關節翻修術的35例（35髖）患者臨床資料。男12例，女23例；年齡47～79歲，平均64.8歲。初次關節置換至翻修術時間為1～15年，中位時間9.7年。翻修原因：假體無菌性松動32例，股骨假體周圍Vancouver B3型骨折2例，低毒性感染1例。髖臼側骨缺損根據美國骨科醫師協會（AAOS）分型標準：Ⅰ型6例，Ⅱ型9例，Ⅲ型20例；根據 Paprosky分型標準：ⅡA型5例，ⅡB型9例，ⅡC型13例，ⅢA型8例。初次置換臼杯外徑為46～52 mm，平均49.6 mm。翻修臼杯外徑為56～68 mm，平均60.4 mm。采用Harris評分評價髖關節功能，并攝X線片行影像學評價。結果術后患者切口均Ⅰ期愈合，無感染及神經、血管損傷等并發癥發生。1例患者于術后20 d發生假體脫位，對癥處理后未再次脫位。35例患者均獲隨訪，1例于術后6年死亡，其余34例患者隨訪時間2～14年，平均8.4年。髖關節Harris評分從術前的（46.4 ± 13.4）分提高至末次隨訪時的（90.4 ± 3.6）分，比較差異有統計學意義（t=18.76，P=0.00）。X線片復查示，術后即刻髖關節旋轉中心距淚滴間線距離、距淚滴外側距離均較術前顯著改善（P lt; 0.05）。除1 例于術后10年出現髖臼假體無菌性松動行二次翻修術外，其余患者臼杯與骨面均無連續性透亮帶、假體移位及骨溶解，臼杯均呈骨性固定。結論采用超大生物型臼杯行髖關節翻修術具有操作簡便、植骨量少、易恢復髖關節旋轉中心等優點，可獲得較好療效。

引用本文： 方遠,孫俊英,查國春,王濤,魏召勸,董圣杰. 采用超大生物型臼杯行髖關節翻修術的療效觀察. 中國修復重建外科雜志, 2013, 27(12): 1424-1427. doi: 10.7507/1002-1892.20130312 復制

1.	孫俊英. 人工髖關節翻修手術學. 北京: 人民軍醫出版社, 2012: 237-240.
2.	Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1352-1357.
3.	孫俊英, 蔣建農, 王禹基, 等. 采用超大型臼杯生物學固定行臼杯翻修術. 江蘇醫藥, 2005, 31(2): 93-95.
4.	Jasty M. Jumbo cups and morselized graft. Orthop Clin North Am, 1998, 29(2): 249-254.
5.	Obenaus C, Winkler H, Girtler R, et al. Extra-large press-fit cups without screws for acetabular revision. J Arthroplasty, 2003, 18(3): 271-277.
6.	Patel JV, Masonis JL, Bourne RB, et al. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty, 2003, 18(2): 129-133.
7.	Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
8.	Hendricks KJ, Harris WH. Revision of failed acetabular components with use of so-called jumbo noncemented components. A concise follow-up of a previous report. J Bone Joint Surg (Am), 2006, 88(3): 559-563.
9.	D’Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1989, (243): 126-137.
10.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
11.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
12.	Schmalzried TP, Harris WH. The Harris-Galante porous-coated acetabular component with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years. J Bone Joint Surg (Am), 1992, 74(8): 1130-1139.
13.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14.	Moore MS, McAuley JP, Young AM, et al. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res, 2006, (444): 176-183.
15.	Wedemeyer C, Neuerburg C, Heep H, et al. Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg, 2008, 128(6): 545-550.
16.	Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
17.	Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
18.	Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.

1. 孫俊英. 人工髖關節翻修手術學. 北京: 人民軍醫出版社, 2012: 237-240.
2. Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1352-1357.
3. 孫俊英, 蔣建農, 王禹基, 等. 采用超大型臼杯生物學固定行臼杯翻修術. 江蘇醫藥, 2005, 31(2): 93-95.
4. Jasty M. Jumbo cups and morselized graft. Orthop Clin North Am, 1998, 29(2): 249-254.
5. Obenaus C, Winkler H, Girtler R, et al. Extra-large press-fit cups without screws for acetabular revision. J Arthroplasty, 2003, 18(3): 271-277.
6. Patel JV, Masonis JL, Bourne RB, et al. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty, 2003, 18(2): 129-133.
7. Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
8. Hendricks KJ, Harris WH. Revision of failed acetabular components with use of so-called jumbo noncemented components. A concise follow-up of a previous report. J Bone Joint Surg (Am), 2006, 88(3): 559-563.
9. D’Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1989, (243): 126-137.
10. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
12. Schmalzried TP, Harris WH. The Harris-Galante porous-coated acetabular component with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years. J Bone Joint Surg (Am), 1992, 74(8): 1130-1139.
13. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14. Moore MS, McAuley JP, Young AM, et al. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res, 2006, (444): 176-183.
15. Wedemeyer C, Neuerburg C, Heep H, et al. Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg, 2008, 128(6): 545-550.
16. Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
17. Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
18. Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.

《中國修復重建外科雜志》

采用超大生物型臼杯行髖關節翻修術的療效觀察

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《中國修復重建外科雜志》

采用超大生物型臼杯行髖關節翻修術的療效觀察

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