采用超大生物型臼杯行髋关节翻修术的疗效观察_《中国修复重建外科杂志》

作者：

方远 , 孙俊英 , 查国春 , 王涛 , 魏召劝 , 董圣杰

苏州大学附属第一医院骨科（江苏苏州，215006）;

关键词：

超大生物型臼杯髋关节翻修术假体无菌性松动股骨假体周围骨折

DOI：

10.7507/1002-1892.20130312

视频：

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目的探讨采用超大生物型臼杯行髋关节翻修术的临床疗效。方法回顾分析1996年5月－2011年5月，采用超大生物型臼杯行髋关节翻修术的35例（35髋）患者临床资料。男12例，女23例；年龄47～79岁，平均64.8岁。初次关节置换至翻修术时间为1～15年，中位时间9.7年。翻修原因：假体无菌性松动32例，股骨假体周围Vancouver B3型骨折2例，低毒性感染1例。髋臼侧骨缺损根据美国骨科医师协会（AAOS）分型标准：Ⅰ型6例，Ⅱ型9例，Ⅲ型20例；根据 Paprosky分型标准：ⅡA型5例，ⅡB型9例，ⅡC型13例，ⅢA型8例。初次置换臼杯外径为46～52 mm，平均49.6 mm。翻修臼杯外径为56～68 mm，平均60.4 mm。采用Harris评分评价髋关节功能，并摄X线片行影像学评价。结果术后患者切口均Ⅰ期愈合，无感染及神经、血管损伤等并发症发生。1例患者于术后20 d发生假体脱位，对症处理后未再次脱位。35例患者均获随访，1例于术后6年死亡，其余34例患者随访时间2～14年，平均8.4年。髋关节Harris评分从术前的（46.4 ± 13.4）分提高至末次随访时的（90.4 ± 3.6）分，比较差异有统计学意义（t=18.76，P=0.00）。X线片复查示，术后即刻髋关节旋转中心距泪滴间线距离、距泪滴外侧距离均较术前显著改善（P lt; 0.05）。除1 例于术后10年出现髋臼假体无菌性松动行二次翻修术外，其余患者臼杯与骨面均无连续性透亮带、假体移位及骨溶解，臼杯均呈骨性固定。结论采用超大生物型臼杯行髋关节翻修术具有操作简便、植骨量少、易恢复髋关节旋转中心等优点，可获得较好疗效。

引用本文： 方远,孙俊英,查国春,王涛,魏召劝,董圣杰. 采用超大生物型臼杯行髋关节翻修术的疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1424-1427. doi: 10.7507/1002-1892.20130312 复制

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6.	Patel JV, Masonis JL, Bourne RB, et al. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty, 2003, 18(2): 129-133.
7.	Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
8.	Hendricks KJ, Harris WH. Revision of failed acetabular components with use of so-called jumbo noncemented components. A concise follow-up of a previous report. J Bone Joint Surg (Am), 2006, 88(3): 559-563.
9.	D’Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1989, (243): 126-137.
10.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
11.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
12.	Schmalzried TP, Harris WH. The Harris-Galante porous-coated acetabular component with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years. J Bone Joint Surg (Am), 1992, 74(8): 1130-1139.
13.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14.	Moore MS, McAuley JP, Young AM, et al. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res, 2006, (444): 176-183.
15.	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.
16.	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.
17.	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.
18.	Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.

1. 孙俊英. 人工髋关节翻修手术学. 北京: 人民军医出版社, 2012: 237-240.
2. 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.
3. 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.
4. Jasty M. Jumbo cups and morselized graft. Orthop Clin North Am, 1998, 29(2): 249-254.
5. Obenaus C, Winkler H, Girtler R, et al. Extra-large press-fit cups without screws for acetabular revision. J Arthroplasty, 2003, 18(3): 271-277.
6. Patel JV, Masonis JL, Bourne RB, et al. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty, 2003, 18(2): 129-133.
7. Gustke KA. Jumbo cup or high hip center: is bigger better? J Arthroplasty, 2004, 19(4 Suppl 1): 120-123.
8. Hendricks KJ, Harris WH. Revision of failed acetabular components with use of so-called jumbo noncemented components. A concise follow-up of a previous report. J Bone Joint Surg (Am), 2006, 88(3): 559-563.
9. D’Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res, 1989, (243): 126-137.
10. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
11. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
12. Schmalzried TP, Harris WH. The Harris-Galante porous-coated acetabular component with screw fixation. Radiographic analysis of eighty-three primary hip replacements at a minimum of five years. J Bone Joint Surg (Am), 1992, 74(8): 1130-1139.
13. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
14. Moore MS, McAuley JP, Young AM, et al. Radiographic signs of osseointegration in porous-coated acetabular components. Clin Orthop Relat Res, 2006, (444): 176-183.
15. 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.
16. 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.
17. 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.
18. Brooks PJ. The jumbo cup: the 95% solution. Orthopedics, 2008, 31(9): 913, 915.

《中国修复重建外科杂志》

采用超大生物型臼杯行髋关节翻修术的疗效观察

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《中国修复重建外科杂志》

采用超大生物型臼杯行髋关节翻修术的疗效观察

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