A new CT-guided minimally invasive surgical approach for the treatment of periacetabular osteolysis -Changing the way we approach the treatment of pelvic osteolysis

机译:一种新的CT引导的微创手术方法,用于治疗终止式骨质溶解 - 调谐我们接近骨盆骨解的治疗方法



Objectives: Today, the decision to operate on a patient with extensive osteolysis is based on the likelihood that a well-fixed cup may become loose after a certain undetermined period. In a radiographically stable cup, excessive osteolysis can occur as a result of wear. When preoperative evaluation determines that the component is not loose but can become unstable as a result of ongoing osteolytic process around it, then the conventional surgical approach is to evaluate the condition of the metal shell intraoperatively and to try debridement of accessible pelvic osteolytic lesions followed by grafting with particulate graft material. Surgical access to these lesions is always difficult, and surgical removal and grafting of the lesion is also unsatisfactory. When osteolytic lesions lead to segmental defects and/or involve the posterior and/or anterior column, removal of bone ingrown shells causes additional substantial bone loss. CT can be used as a screening tool and could differentiate between progressive osteolysis and retroacetabular stress shielding that simply reflects stable osseous integration of the acetabular press-fit fixation [1, 4]. A computer-assisted surgical approach for patients with CT-detected osteolytic lesions would enable the surgeon to treat these progressive osteolytic lesions early before loosening occurs or the cup becomes unstable, thereby eliminating the need for revision surgery (cup removal) and its associated risks.
机译:目的:今天,在具有广泛骨溶解的患者身上操作的决定是基于在一定的未确定时期后固定杯子可能变得松动的可能性。在射线照相稳定的杯中,由于磨损而可能发生过量的骨解。当术前评估确定组件不松动但由于围绕它的持续骨溶解过程可能变得不稳定,那么传统的手术方法是术中评价金属壳的状况,并尝试可接近的盆腔骨解性病变的清新后用颗粒状接枝材料接枝。对这些病变的外科手术始终困难,外科手术和嫁接的病变也不令人满意。当骨溶解损伤导致节段缺陷和/或涉及后/或前柱时,去除骨头向内壳导致额外的大量骨质损失。 CT可以用作筛选工具,并且可以区分渐进式骨溶解和止回网应力屏蔽,这简单地反映了髋臼压配固定的稳定骨质整合[1,4]。用于CT检测的骨解性病变患者的计算机辅助手术方法将使外科医生能够在松动发生之前早期治疗这些渐进式骨分解病变,或者杯子变得不稳定,从而消除了对修复手术(杯脱离)及其相关风险的需求。



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