【作者】 高宏伟；

【导师】 张远鹰；

【作者基本信息】 吉林大学 ， 外科学， 2011， 硕士

【摘要】 近年来,随着骨科学手术技术的提高及假体材料的进步,人工全髋关节置换术的手术数量急剧增加,人工全髋关节置换术的手术技术亦日益成熟。但仍有许多问题需要临床医生解决。髋臼骨缺损就是骨科医生在进行人工全髋关节置换术时所需要面对的常见问题及难题。髋臼侧骨缺损的处理方法繁多,因缺损类型不同而治疗方法不同,且疗效各异。本文通过对我院进行的23例伴髋臼侧骨缺损的人工全髋关节置换术的随访结果的报道,初步分析了骨移植技术在髋臼侧骨缺损的治疗中的应用及疗效情况,以期为临床活动提供参考。目的：通过对23例行人工全髋关节置换术的髋臼骨缺损患者的治疗结果的随访来探讨骨移植技术在骨缺损治疗中的作用及疗效。方法：对我院自2009年2月至2010年11月收治的符合本论文要求的23例髋臼骨缺损的患者采用人工全髋关节置换术治疗,并采用不同骨移植方法来填补髋臼侧骨缺损。对所有患者进行定期随访,记录术前术后髋关节功能变化,定期拍摄双髋关节正位X线片,评价骨长入情况、髋臼侧有无骨溶解及假体松动程度。在髋臼缺损类型、植骨类型、术前术后髋关节功能差异、一定时间内有无骨溶解及假体松动进行评估和报道。在所有23例髋臼侧骨缺损的患者中,其中先天性髋关节脱位、髋臼发育不良10例,全髋关节置换术后髋臼侧假体松动7例,陈旧性髋臼骨折、股骨头坏死2例,陈旧性股骨颈骨折1例,股骨头缺血性坏死3例。术后随访3至24个月,平均13.5个月。髋臼侧骨缺损按照Paprosky分型：PaproskyⅡA型14例,PaproskyⅡB型6例,PaproskyⅡC型1例, PaproskyⅢA型2例。结果：所有患者平均随访13.5个月,Harris髋关节评分从术前平均37.1分提高到术后平均78.7分。其中结构性植骨组11例患者中1例发生髋臼侧移植骨愈合不良,1例发生髋臼侧假体松动、螺钉断裂,行全髋关节翻修术。颗粒性植骨组和结构性植骨联合颗粒性植骨组骨愈合平均时间短,未见假体松动、骨溶解现象,总有效率为91.3%。结论：1.对伴髋臼骨缺损的全髋关节置换术,骨移植术可重建髋臼,是一种临床价值较高的治疗方法,短期临床效果理想；2.颗粒性植骨较结构性植骨骨愈合时间短,结构性植骨联合颗粒性植骨较单纯结构性植骨骨愈合时间短,在髋臼大块植骨时应辅以颗粒性植骨以缩短骨愈合时间。更多还原

【Abstract】 As the development of the orthopedic operation methods and materials, the number of the total hip arthroplasty (THA) has increased sharply in recent years, also the surgical technique of the total hip arthroplasty has been more and more mature. However, there also been many questions in the THA to the orthopedic doctor. For example, the actabular bone defect is a simple but difficult problem. There are so many methods to deal with the actabular bone defect, and they have different indications but have different effects. In this paper, we will report the follow-up result of 23 patients been treated with total hip arthroplasty because of actabular bone defect, and analysised the application and effect of bone allograft treated actabular bone defect, with the hope that it can provide reference to clinical work.Objective:To investigate the application of the bone allograft of bone defect in the total hip arthroplasty through 23 cases treated in our hospital, and observe the clinical effect and give some advice to the clinical practice.Method:23 qualified total hip arthroplasty (THA) were enrolled in this study from February 2009 to November 2010 treated in out hospital. They had different type acetabular bone defect and were done different type allograft. They were asked to have regular review after operation and have X-ray examination of the hip joint, and evaluate the function of the hip joint at every review time. The bone defect were classified by Paprosky classfication,14 cases belong to typeⅡA,6 cases belong to typeⅡB,1 case belongs to typeⅡC and 2 cases belong to typeⅢA.For diagnosis,10 cases belong to congenital dislocation of the hip and acetabular dysplasia,7 cases belong to acetabular components loosening,3 cases belong to femoral head necrosis,2 cases belong to old fracture of acetabular and femoral head necrosis and 1 case belongs to old fracture of femoral neckResults:All the 23 patients had at least 3 months(main 13.5 months,from 3 months to 24 months).The Harris points increase from 37.1 preoperation to 78.7 point postoperation.In the group of structure allograft,only on case showed translucent zone among actabular compont at X ray but had no clinical symptom,one case had screw fracture and had revision operation.The time of bone healing in the group of morselized bone allograft and mixed allograft group is shorter than the group of structure allograft.The total effective rate is 91.3%.Conclusions:1. The bone allograft is a kind of valuable method to acetabular reconstruction and bone defect of acetabular;2. The bone healing time of morselized bone allograft and mixed group is shorter than structure allograft. When we do the total hip arthroplasty of severe bone defect of actabular,we should use structure allograft united morselized bone allograft.更多还原