【作者】 孙鹏程；

【导师】 刘培来；

【作者基本信息】 山东大学 ， 外科学（专业学位）， 2013， 硕士

【摘要】 目的：对初次行全髋关节置换术中髋臼缺损进行自体股骨头髋臼重建,观察临床疗效,总结初次全髋关节置换术中髋臼重建的方法和经验,为临床工作提供指导和参考。方法：将2009年5月至2012年8月间收治的35例共41例髋进行初次全髋关节置换术髋臼缺损的患者,其中发育性髋关节发育不良21例,股骨头坏死6,单纯骨性关节炎7例,创伤性髋关节炎1例,按美国关节协会(AAOS)分型,其中Ⅰ型20例,Ⅱ型16例,Ⅲ型5例,Ⅰ型与Ⅱ型行自体股骨头颗粒打压植骨,Ⅲ型行自体股骨头结构性植骨；通过门诊复查随访观察患者术后并发症、移植骨愈合情况、假体松动情况、按照Harris髋关节评分系统评价术后功能恢复情况,恢复情况分为优、良、一般、差四个等级,并计算其优良率。结果：患者术后刀口均一期愈合,未发生感染及重要神经损伤,术后1例不完全右侧肺静脉栓塞者,术后平均随访22(9～42)个月,Harris评分平均为由术前的46.3分到术后的91.8分(P＜0.01),髋关节假体周围透亮带者4例,其中2例为股骨头坏死,2例为发育性髋关节发育不良,术后继续随访未见透亮带继续增大,其中无假体松动及翻修病例,Harris评分其中恢复优良率占97.1%。结论：对于初次行全髋关节置换术髋臼缺损的患者(AAOS I型～Ⅲ型),根据髋臼缺损类型选用不同方法使用自体股骨头重建髋臼可取得良好临床疗效,手术建议由经验丰富的医生完成。对于股骨头坏死患者选用自体股骨头颗粒植骨及结构性植骨应剔除软骨,建议选用良好的股骨头松质骨或者同种异体股骨头进行髋臼重建。充足的术前准备及术前计划是全髋关节置换术及髋臼重建的一个重要环节。更多还原

【Abstract】 Objective:Observing the clinical effects of acetabular reconstruction which was used with the autologous femoral head in primary total hip arthroplasty, we summarized the methods and experience in order to provide guidance and reference for clinical treatment.Methods:35cases of patients with acetabular defects were treated with primary total hip arthroplasty from May2009to August2012, in which21cases were developmental dysplasia of hip,6cases were necrosis of femoral head,7cases were pure osteoarthritis, and only1case was traumatic arthritis. According to the American Academy of Orthropedic Surgons, we classified the41cases to3groups, which included20cases type Ⅰ,16cases of type Ⅱ and5cases of type Ⅲ. Type Ⅰ and Ⅱ were treated with impaction bone graft with morserlised bone of autologous femoral head. Type Ⅲ was treated with structural bone graft with autologous femoral head. Thought outpatient reexamination, we evaluated the postoperation complications, prosthesis loosening and bone graft healing. According to the Harris hip score, the recovery was divided into poor four, common, good and excellent levels, and finally we calculated group’s excellent rate.Results:The incisions were all first-stage healing, and no infection and nerve injury happened. And one patient happened with pulmonary embolism. The average follow-up was22(9～42) months, the mean Harris score was enhanced from46.3to91.8point (P<0.01). There was no prosthesis loosening and revision. There were4cases with radiolucent llines around the prosthesis of which2cases were necrosis of femoral head and2cases were developmental dysplasia of hip. And then we did not found the radiolucent was enlarged in the follow-up.Conclusion:For the patients with acetabular defect(AAOS type Ⅰ～typeⅡ) in primary THA, autograft femoral head could achieve good clinical effects when we made the acetabular reconstruction according to the type of the acetabular defects. The surgery should be finished by the experienced surgeons. And choosing the good cancellous bone of femoral head without cartilage or the allograft bone was a good choice, for the acetabular construction of primary total hip arthroplasty(THA). And the preoperative planning was important for THA.更多还原