异体颗粒松质骨移植治疗髋臼杯稳定的髋臼周围骨溶解.DOCVIP

临床医学论文-异体颗粒松质骨移植治疗髋臼杯稳定的髋臼周围骨溶解 ?????????????????作者： 廉永云,裴福兴　冯卫，Yoon 【关键词】? 非骨水泥髋臼杯 ??? 摘? 要：［目的］评价异体颗粒松质骨移植治疗THA术后髋臼杯稳定的髋臼周围骨溶解的效果。［方法］自1996年4月~2000年7月，对26例髋臼杯周围骨溶解而假体稳定者行保留髋臼杯，清除病灶、异体颗粒松质骨移植术，并更换聚乙烯内衬和股骨头假体。术后平均随访55 a。对临床结果、骨溶解病变范围和骨移植愈合分别用Harris髋关节评分系统、放射线影像学和骨移植愈合分级系统进行评价。［结果］Harris评分由翻修术前的平均82分增加到术后平均88分；X线片示髋臼杯周围骨溶解范围正位由术前238 mm×249 mm减小到术后115 mm×82 mm，侧位由术前的111 mm×116 mm减少到术后53 mm×45 mm；异体骨愈合程度Ⅰ级12例（46％），Ⅱ级14例（54％）。［结论］保留髋臼杯、清除病灶后行异体颗粒松质骨移植术是非骨水泥髋臼杯稳定的髋臼周围骨溶解治疗的有效措施，可以保留更多的髋臼骨量，降低手术的复杂程度。 ??? 关键词：非骨水泥髋臼杯；? 骨溶解；? 人工全髋关节翻修术；? 异体骨；? 颗粒型骨移植 ??? Abstract：［Objective］To evaluate the clinical and radiological results of a curettage of granulation tissue,the exchange of polyethylene liner and morselized bone grafting for the treatment of osteolysis around a stable cementless acetabular cup［Method］From Apr1996 to Jul2000,26 patients underwent revision of curettage of granulation tissue,the exchange of polyethylene liner and morselized allografting,which were followed up for an average of 55 yearsThe Harris Hip Score was used to evaluate the clinical resultThe size of osteolysis of periacetabular cup was measured in AP and lateral view of XraysThe allograft union was evaluated with the bone graft incorporation scale［Result］Clinically,the average HHS increased from 82 to 88 points postoperativelyRadiologically,the size of osteolysis of peraacetabular cup changed from average 238 mm×249 mm to 115 mm×82 mm in the AP view,and from 111 mm×116 mm to 53 mm×45 mm in the lateral viewThe bone graft incorporation scales were Grade Ⅰ and Ⅱ in 12 and 14 cases,respectively［Conclusion］The Curettage of granulation tissues,morselized bone grafting and exchange of polyethylene liner and femoral head is an effective therapy in osteolysis around a stable cementless acetabular cup and could preserve the bone stock for the further revision THA ??? Key words：Cementless acetabular cup;? Osteotysis;? Revision total hip arthroplasty;? Morselized bone graft;? Allograft ??? 非骨水泥型人工全髋关节置换术（total hi