加大号生物型臼杯在人工髋关节翻修术中的应用_《中国修复重建外科杂志》

作者：

黄子达 , 张文明 , 林建华 , 李文波 , 白国昌 , 沈荣凯

福建医科大学附属第一医院关节外科（福州，350001）;

关键词：

加大号生物型臼杯人工髋关节翻修术髋臼侧骨缺损生物型固定

DOI：

10.7507/1002-1892.20130287

视频：

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目的探讨在人工髋关节翻修术中应用加大号生物型臼杯（Jumbo杯）解决广泛髋臼侧骨缺损的早期疗效。方法2008年9月－2012年5月，对13例13髋合并广泛髋臼侧骨缺损的患者行人工髋关节翻修术，均使用Jumbo杯（男性直径≥64 mm，女性直径≥60 mm）。其中男4例，女9例；年龄58～84岁，平均64.7岁。均为单侧首次翻修；翻修距人工全髋关节置换术时间3～16年，平均9.6年；髋臼侧骨缺损根据Paprosky分型：ⅡA型2例，ⅡB型5 例，ⅡC型4例，ⅢA型2例。术前测量股骨头假体中心至两侧泪滴连线的垂直距离较健侧增加（21.2 ± 6.1）mm。手术前后行Harris评分及评估髋关节旋转中心变化情况。结果术后切口均Ⅰ期愈合，无关节脱位、感染及坐骨神经、股神经损伤发生。13例均获随访，随访时间13～40个月，平均23.5个月。患者术后髋关节疼痛均不同程度缓解或消失；除1例术后3个月因急性脑梗死致肢体偏瘫外，余患者均能正常下地行走，恢复大部分日常工作。5例植骨患者随着随访时间延长，X线片示植入的同种异体骨逐渐与宿主骨整合，无明显吸收；植骨融合时间9～35个月，平均14.5个月。末次随访时，股骨头中心点与双侧泪滴连线的垂直距离较健侧增加（6.0 ± 3.1）mm，较术前明显下降（t=11.13，P=0.00）；假体周围无透亮区，假体无移位，螺钉无断裂；Harris评分为（85.1 ± 3.2）分，较术前（30.4 ± 8.8）分显著增加，差异有统计学意义（t=22.11，P=0.00）。结论使用Jumbo杯可有效解决伴广泛髋臼侧骨缺损的重建问题，早期疗效满意，假体长期生存率仍需进一步观察。

引用本文： 黄子达,张文明,林建华,李文波,白国昌,沈荣凯. 加大号生物型臼杯在人工髋关节翻修术中的应用. 中国修复重建外科杂志, 2013, 27(11): 1313-1317. doi: 10.7507/1002-1892.20130287 复制

1.	陈伟, 谷长跃, 于庆巍, 等. 植骨技术结合金属网杯重建髋臼骨缺损在全髋关节置换术中的应用. 中华骨科杂志, 2012, 32(9): 823-829.
2.	叶一林, 朱天岳, 柴卫兵, 等. 混合植骨技术结合髋臼加强杯或钛网杯重建髋臼严重骨缺损. 中华骨科杂志, 2012, 32(9): 830-836.
3.	Colen S, Harake R, De Haan J, et al. A modified custom-made triflanged acetabular reconstruction ring (MCTARR) for revision hip arthroplasty with severe acetabular defects. Acta Orthop Belg, 2013, 79(1): 71-75.
4.	Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1352-1357.
5.	Wedemeyer C, Neuerburg C, Heep H, et al. Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg, 2008, 128(6): 545-550.
6.	Dearborn JT, Harris WH. Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. J Arthroplasty, 2000, 15(1): 8-15.
7.	Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
8.	Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
9.	Lee JM, Nam HT. Acetabular revision total hip arthroplasty using an impacted morselized allograft and a cementless cup: minimum 10-year follow-up. J Arthroplasty, 2011, 26(7): 1057-1060.
10.	van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg (Br), 2007, 89(3): 296-300.
11.	林博文, 黎伟凡, 王华, 等. 异体骨移植在髋关节翻修术中应用的10年随访. 中华关节外科杂志(电子版), 2012, 6(4): 523-529.
12.	孙俊英, 蒋建农, 王禹基, 等. 采用超大型臼杯生物学固定行臼杯翻修术. 江苏医药, 2005, 31(2): 93-95.
13.	Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
14.	张媺, 白鹏程, 江建平, 等. 螺旋型髋臼与压配型髋臼的临床应用分析. 中国组织工程研究, 2012, 16(22): 4031-4034.
15.	Bozic KJ, Freiberg AA, Harris WH. The high hip center. Clin Orthop Relat Res, 2004, (420): 101-105.
16.	Jerosch J, Steinbeck J, Stechmann J, et al. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg, 1997, 116(6-7): 385-389.
17.	周建生, 王志岩, 肖玉周, 等. 人工髋关节翻修旋转中心重建的临床研究. 中华骨科杂志, 2011, 31(5): 475-480.
18.	周绪光, 李军伟, 王义生, 等. 精确预测髋臼杯型号的数字X线片放大率测量方法. 中国实用医刊, 2012, 39(19): 31-33.
19.	Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.
20.	Girard J, Kern G, Migaud H, et al. Primary total hip arthroplasty revision due to dislocation: Prospective French multicenter study. Orthop Traumatol Surg Res, 2013. [Epub ahead of print].
21.	Stroh DA, Issa K, Johnson AJ, et al. Reduced dislocation rates and excellent functional outcomes with large-diameter femoral heads. J Arthroplasty, 2013. [Epub ahead of print].
22.	Prokopetz JJ, Losina E, Bliss RL, et al. Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord, 2012, 13: 251.
23.	Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
24.	Garbuz DS, Masri BA, Duncan CP, et al. The Frank Stinchfield Award: Dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res, 2012, 470(2): 351-356.

1. 陈伟, 谷长跃, 于庆巍, 等. 植骨技术结合金属网杯重建髋臼骨缺损在全髋关节置换术中的应用. 中华骨科杂志, 2012, 32(9): 823-829.
2. 叶一林, 朱天岳, 柴卫兵, 等. 混合植骨技术结合髋臼加强杯或钛网杯重建髋臼严重骨缺损. 中华骨科杂志, 2012, 32(9): 830-836.
3. Colen S, Harake R, De Haan J, et al. A modified custom-made triflanged acetabular reconstruction ring (MCTARR) for revision hip arthroplasty with severe acetabular defects. Acta Orthop Belg, 2013, 79(1): 71-75.
4. Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(9): 1352-1357.
5. Wedemeyer C, Neuerburg C, Heep H, et al. Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg, 2008, 128(6): 545-550.
6. Dearborn JT, Harris WH. Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. J Arthroplasty, 2000, 15(1): 8-15.
7. Fan CY, Chen WM, Lee OK, et al. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg, 2008, 128(8): 809-813.
8. Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
9. Lee JM, Nam HT. Acetabular revision total hip arthroplasty using an impacted morselized allograft and a cementless cup: minimum 10-year follow-up. J Arthroplasty, 2011, 26(7): 1057-1060.
10. van Haaren EH, Heyligers IC, Alexander FG, et al. High rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg (Br), 2007, 89(3): 296-300.
11. 林博文, 黎伟凡, 王华, 等. 异体骨移植在髋关节翻修术中应用的10年随访. 中华关节外科杂志(电子版), 2012, 6(4): 523-529.
12. 孙俊英, 蒋建农, 王禹基, 等. 采用超大型臼杯生物学固定行臼杯翻修术. 江苏医药, 2005, 31(2): 93-95.
13. Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
14. 张媺, 白鹏程, 江建平, 等. 螺旋型髋臼与压配型髋臼的临床应用分析. 中国组织工程研究, 2012, 16(22): 4031-4034.
15. Bozic KJ, Freiberg AA, Harris WH. The high hip center. Clin Orthop Relat Res, 2004, (420): 101-105.
16. Jerosch J, Steinbeck J, Stechmann J, et al. Influence of a high hip center on abductor muscle function. Arch Orthop Trauma Surg, 1997, 116(6-7): 385-389.
17. 周建生, 王志岩, 肖玉周, 等. 人工髋关节翻修旋转中心重建的临床研究. 中华骨科杂志, 2011, 31(5): 475-480.
18. 周绪光, 李军伟, 王义生, 等. 精确预测髋臼杯型号的数字X线片放大率测量方法. 中国实用医刊, 2012, 39(19): 31-33.
19. Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.
20. Girard J, Kern G, Migaud H, et al. Primary total hip arthroplasty revision due to dislocation: Prospective French multicenter study. Orthop Traumatol Surg Res, 2013. [Epub ahead of print].
21. Stroh DA, Issa K, Johnson AJ, et al. Reduced dislocation rates and excellent functional outcomes with large-diameter femoral heads. J Arthroplasty, 2013. [Epub ahead of print].
22. Prokopetz JJ, Losina E, Bliss RL, et al. Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord, 2012, 13: 251.
23. Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
24. Garbuz DS, Masri BA, Duncan CP, et al. The Frank Stinchfield Award: Dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res, 2012, 470(2): 351-356.

《中国修复重建外科杂志》

加大号生物型臼杯在人工髋关节翻修术中的应用

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《中国修复重建外科杂志》

加大号生物型臼杯在人工髋关节翻修术中的应用

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