打压植骨结合结构性植骨重建成人髋臼发育不良性骨缺损

Impacted bone graft combined with structural bone graft for the reconstruction of acetabular bone defects in adult developmental dysplasia of hip

摘要:

目的：探讨全髋置换术中应用打压植骨结合结构性植骨在重建成人髋臼发育不良（developmental dysplasia of hip，DDH）性骨缺损中的疗效。方法：回顾性分析2007年1月-2012年6月，在我科治疗的成人DDH 11例患者，发育不良按Crowe分型为Ⅱ型5例，Ⅲ型6例；骨缺损按美国骨科医师学会分类术前均为Ⅲ型混合型缺损。3例用同种异体股骨头，8例用自体股骨头进行结构性植骨，均用2、3枚螺钉固定。1例用骨水泥型带加强环的臼杯，10例用非骨水泥型带螺旋臼杯压配固定。均取股骨侧髓腔或自体髂骨碎粒打压植骨。术中不同程度松解髋周组织。结果：所有患者顺利完成手术，无1例感染。经6~48个月的随访，未发现关节疼痛、臼杯松动。Harris评分由术前的平均39.7分（18~52分）提高到术后末次随访时的平均85.7分（52~96分）。结论：结构性植骨及合适的臼杯能提供髋臼骨缺损的结构性即时支撑，打压植骨颗粒能提供充足的骨量支持从而促进臼杯与骨床的融合。

Abstract:

Objective：To explore the clinical effects of impacted bone graft combined with structural bone graft for the reconstruction of acetabular bone defects in adult developmental dysplasia of hip（DDH）. Methods：Totally 11 adult patients suffered from DDH were treated in our hospital from January 2007 to June 2012. According to Crowe classification，there were 5 cases of type Ⅱ and 6 cases of type Ⅲ dysplasia，respectively. All acetabular bone defects were type Ⅲ defects（combined defects） according to the American Academy of Orthopaedic Surgeons classification. Femoral head allograft and femoral head autograft were used in structural bone graft for 3 cases and 8 cases，restpectively. All defects were further treated with autologous bone acquired from the femur or ilium using impacted morselized bone grafting technique. Results：Patients were followed up for 6-48 months，with no complications such as infection，hip pain and cup loosening being observed. Average Harris hip score increased from 39.7（18-52） before the surgery to 85.7（52-96） at the last follow-up. Conclusions：Structural bone graft and appropriate cup can provide instant support for the acetabular bone defects，while impacted bone graft can promote the fusion of acetabular cup with surrounding bone.