目的 探讨在髋关节翻修术中联合应用钽金属骨小梁臼杯与钽金属加强块重建Paprosky Ⅱ型和Ⅲ型髋臼缺损的早期疗效.方法 回顾性分析2014年6月至2016年4月因假体无菌性松动接受髋关节翻修术并在术中使用钽金属骨小梁臼杯联合钽金属加强块重建Paprosky Ⅱ型和Ⅲ型髋臼缺损的患者17例(17髋),男5例,女12例;年龄30～75岁,平均56.6岁.PaproskyⅡ A型4例,Ⅱ B型3例,Ⅲ A型8例,Ⅲ B型2例.全髋关节翻修术13例,仅翻修髋臼侧4例.随访时评估Harris髋关节评分,观察并发症发生情况,测量髋关节旋转中心相对于泪滴位置的改变,观察钽金属骨小梁臼杯及钽金属加强块骨长入程度及假体周围透光线.结果 17例患者随访11～33个月,平均23个月.末次随访所有患者均无假体相关感染、脱位及周围骨折等并发症.Harris髋关节评分由术前(45.8±3.4)分提高至(79.2±7.5)分,差异有统计学意义(t=-16.8,P=0.00);患侧髋关节旋转中心至泪滴连线的垂直距离由术前(32.1±4.3) mm降至(14.5±2.3) mm,差异有统计学意义(t=14.8,P=0.00);患侧髋关节旋转中心至泪滴的水平距离由术前(33.6±6.1)mm降至(27.8±3.2) mm,差异有统计学意义(t=3.5,P=0.00).末次随访时11例(65％,11/17)患者的X线片提示有良好的骨长入;假体均未见外展角或前倾角变化,臼杯及钽金属加强块均牢固固定.结论 髋关节翻修术中应用钽金属骨小梁臼杯联合钽金属加强块重建Paprosky Ⅱ型和Ⅲ型髋臼缺损,可避免使用过大直径的臼杯,重建相对正常的髋关节旋转中心,假体初始稳定性可靠,骨长入趋势良好,髋关节功能改善明显.%Objective To investigatc thc short-term clinical and radiographic outcomes of tantalum trabecular metal (TM) components associated with TM augments for Paprosky type Ⅱ and type Ⅲ acetabular defects in revision hip arthroplasty.Methods From June 2014 to April 2016,seventeen patients with aseptic loosening underwent revision total hip arthroplasty for Paprosky type Ⅱ or type Ⅲ acetabular defects with TM revision acetabular cups and TM augments.The subjects consisted of 5 males and 12 females with mean age of 56.6 years (range 30-75).Acetabular bony defects were Paprosky type Ⅱ A in 4 hips,Ⅱ B in 3 hips,Ⅲ A in 8 and Ⅲ B in 2 hips.The whole hip revision was performed in 13 hips and acetabular reconstruction in 4 hips.Preand post-operative functional outcomes were accessed by the Harris Hip Score.The vertical and horizontal position of the rotation center from the intertear drop line were measured and analyzed.Complications were recorded during the follow-up.Radiographic examination was performed after operation immediately by X-ray.The recent X-ray was conducted to assess bone ingrowths at the cup-bone or augments-bone interface,radiolucent lines and implant migration.Results All of the patients were followed-up for an average of 23 months (range 11-33 months).There was no infection,dislocation or periprosthetic fracture complications at the last followed-up.The Harris Hip Score was improved from 45.8±3.4 pre-operatively to 79.2±7.5 post-operatively (t=-16.8,P=0.00).The mean vertical distance of the center of rotation was 32.1±4.3 mm preoperatively and 14.5±2.3 mm postoperatively (t=14.8,P=0.00).The mean horizontal distance of the center of rotation was 33.6±6.1 mm preoperatively and 27.8±3.2 mm postoperatively (t=3.5,P=0.00).More than 3 radiographic signs of osseointegration were observed in 11 hips.No progressive radiolucent lines or component migration was observed.All the TM components were well-fixed at last follow-up.Conclusion Using tantalum TM cups with TM augments in revision hip arthroplasty could be regarded as an effective management for Paprosky type Ⅱ and type Ⅲ acetabular defects.This technology can avoid using over-large cup,provide reliable primary stability,restore the center of rotation with almost normal hip biomechanics and improve the functional outcome.
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