应用钢板和人工骨行全髋关节股骨侧假体翻修11例

中国组织工程研究与临床康复 第15卷 第22期 2011–05–28出版

Journal of Clinical Rehabilitative Tissue Engineering Research May 28, 2011 Vol.15, No.22

应用钢板和人工骨行全髋关节股骨侧假体翻修11例

P .O. Box 1200, Shenyang 110004 http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html

4150

Department of Orthopedics,

People’s Hospital of Hainan Province, Ha ikou 570311, Hainan Province, China

Lin Jian-ping ★, Master, Associate chief physician, Department of Orthopedics,

People’s Hospital of Hainan Province, Ha ikou 570311, Hainan Province, China

linescu@http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html

Received: 2011-02-23 Accepted: 2011-04-06

海南省人民医院创伤骨科,海南省海口市 570311

林坚平★,男,1971年生,海南省儋州市人,汉族,1993年北京大学医学部毕业,布加勒斯特大学医院访问学者,硕士,副主任医师,主要从事人工关节,生物骨的研究与开发。

linescu@163. com

中图分类号:R318 文献标识码:B

文章编号:1673-8225 (2011)22-04150-05

收稿日期:2011-02-23 修回日期:2011-04-06 (20110223017/WL ·W)

应用钢板和人工骨行全髋关节股骨侧假体翻修11例★

林坚平,黎早敏,宋世锋,郑南生,陈剑飞

Application of plate and artificial bone in the revision of femoral prosthesis in 11 cases

Lin Jian-ping, Li Zao-min, Song Shi-feng, Zheng Nan-sheng, Chen Jian-fei

Abstract

BACKGROUND: Most scholars tend to use long-handled cementless prosthesis for revision of Paprosky Ⅲ and Ⅳ defects. However, there is not a more mature view yet on the implant selection, grafting way, whether the plate is used or not.

OBJECTIVE: To review the clinical results of plate and artificial bone in the revision of femoral prosthesis of total hip arthroplasty (RTHA).

METHODS: Eleventh cases (8 cases of Paprosky Ⅲ, 3 of Paprosky Ⅳ) underwent RTHA with cementless techniques, including 4 cases of shape-memory alloy surround plate, 2 cases of compression plate or limited contact-dynamic compress plate (LC-DCP), 5 cases of LISS. All the cases underwent structural reconstruction with use of mesh, cable grip system, impacted allograft and cortical strut. Harris score was developed before and after the revision, and markers such as incision healing, body temperature, ESR, pain, activities of hip joint, daily life, walking and so on were observed in patients.

RESULTS AND CONCLUSION: Postoperative clinical results were evaluated as good in 9 cases (82%), fair in 1 case (9%) and poor in 1 case (9%) which showed immunoresponse. In RTHA for the femoral component for the elderly patients with Paprosky Ⅲ or Ⅳ defects combined with periprosthetic fracture, application of plate and artificial bone can decrease operation time and trauma, fix femoral component stably and quickly, and allow patients to do early functional exercise.

Lin JP, Li ZM, Song SF, Zheng NS, Chen JF. Application of plate and artificial bone in the revision of femoral prosthesis in 11 cases.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(22): 4150-4154. [http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html]

摘要

背景:对于股骨假体paprosky 分型Ⅲ型、Ⅳ型翻修时,大多数学者趋向于采用非骨水泥涂层的长柄翻修假体。但是,关于骨缺损的植骨材料选择、植骨方式、钢板是否可以采用等问题,在骨科界目前尚未有较成熟的意见。 目的:观察同时采用钢板和人工骨进行全髋关节股骨侧假体翻修的疗效。

方法:11例股骨侧假体翻修患者(paprosky 分型Ⅲ型8例,Ⅳ型3例)均采用现代无骨水泥技术,记忆合金环抱钢板4例,加压钢板或有限接触钛板2例,锁定钛板5例,所有病例均使用异体或异种颗粒骨进行嵌压植骨、异体骨板结合钢丝或线缆握紧系统器械进行结构重建。翻修前后髋关节功能按Harris 评分标准进行评价,观察患者手术切口愈合及髋关节活动情况。 结果与结论:11例患者均获得随访,平均13.6个月,Harris 评分优良9例(82%),可1例(9%),差1例(9%)。提示患者股骨侧假体翻修中,同时应用钢板和人工骨进行髋关节股骨侧翻修,能让股骨侧paprosky 分型Ⅲ型和Ⅳ型缺损合并假体周围骨折固定快且牢固,生物型假体即刻达到稳定,手术时间和创伤减少,并允许患者早期进行功能锻炼。 关键词:髋关节置换;翻修;骨移植;假体周围骨折;钢板;支撑植骨 doi:10.3969/j.issn.1673-8225.2011.22.039

林坚平,黎早敏,宋世锋,郑南生,陈剑飞. 应用钢板和人工骨行全髋关节股骨侧假体翻修11例[J].中国组织工程研究与临床康复,2011,15(22):4150-4154. [http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html http://cn.zglck http://m.wendangku.net/doc/2683c5faaef8941ea76e058d.html]

0 引言

随着人工全髋关节置换的广泛开展,全髋

关节翻修病例也逐渐增多。对于股骨假体paprosky 分型Ⅲ型、Ⅳ型翻修时,大多数学者趋向于采用非骨水泥涂层的长柄翻修假体。但是,关于骨缺损的植骨材料选择、植骨方式、钢板是否可以采用等问题,在骨科界目前尚未有较成熟的意见[1]

2001-10/2010-12作者对有严重骨缺损患者进行髋关节翻修时应用了异体骨、异种骨颗粒嵌压植骨、同种异体皮质骨支撑植骨、钛板内固定,取得了良好的效果。

1 对象和方法

设计:回顾性病例分析。

时间及地点:病例来自2001-10/2010-12海南省人民医院创伤骨科。

对象:选择海南省人民医院创伤骨科收治的骨缺损患者11例,男7例,女4例;左侧3例,右侧8例,年龄62~77岁,平均68.6岁;均采用现代无骨水泥技术,记忆合金环抱钢板4例,加压钢板或有限接触钛板2例,锁定钛板5例,所有病例均使用异体或异种颗粒骨进行嵌压植骨、异体骨板结合钢丝或线缆握紧系统器械进行结构重建。

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