加大號生物型臼杯在人工髖關節翻修術中的應用_《中國修復重建外科雜志》

作者：

黃子達 , 張文明 , 林建華 , 李文波 , 白國昌 , 沈榮凱

福建醫科大學附屬第一醫院關節外科（福州，350001）;

關鍵詞：

加大號生物型臼杯人工髖關節翻修術髖臼側骨缺損生物型固定

DOI：

10.7507/1002-1892.20130287

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目的探討在人工髖關節翻修術中應用加大號生物型臼杯（Jumbo杯）解決廣泛髖臼側骨缺損的早期療效。方法2008年9月－2012年5月，對13例13髖合并廣泛髖臼側骨缺損的患者行人工髖關節翻修術，均使用Jumbo杯（男性直徑≥64 mm，女性直徑≥60 mm）。其中男4例，女9例；年齡58～84歲，平均64.7歲。均為單側首次翻修；翻修距人工全髖關節置換術時間3～16年，平均9.6年；髖臼側骨缺損根據Paprosky分型：ⅡA型2例，ⅡB型5 例，ⅡC型4例，ⅢA型2例。術前測量股骨頭假體中心至兩側淚滴連線的垂直距離較健側增加（21.2 ± 6.1）mm。手術前后行Harris評分及評估髖關節旋轉中心變化情況。結果術后切口均Ⅰ期愈合，無關節脫位、感染及坐骨神經、股神經損傷發生。13例均獲隨訪，隨訪時間13～40個月，平均23.5個月。患者術后髖關節疼痛均不同程度緩解或消失；除1例術后3個月因急性腦梗死致肢體偏癱外，余患者均能正常下地行走，恢復大部分日常工作。5例植骨患者隨著隨訪時間延長，X線片示植入的同種異體骨逐漸與宿主骨整合，無明顯吸收；植骨融合時間9～35個月，平均14.5個月。末次隨訪時，股骨頭中心點與雙側淚滴連線的垂直距離較健側增加（6.0 ± 3.1）mm，較術前明顯下降（t=11.13，P=0.00）；假體周圍無透亮區，假體無移位，螺釘無斷裂；Harris評分為（85.1 ± 3.2）分，較術前（30.4 ± 8.8）分顯著增加，差異有統計學意義（t=22.11，P=0.00）。結論使用Jumbo杯可有效解決伴廣泛髖臼側骨缺損的重建問題，早期療效滿意，假體長期生存率仍需進一步觀察。

引用本文： 黃子達,張文明,林建華,李文波,白國昌,沈榮凱. 加大號生物型臼杯在人工髖關節翻修術中的應用. 中國修復重建外科雜志, 2013, 27(11): 1313-1317. doi: 10.7507/1002-1892.20130287 復制

1.	陳偉, 谷長躍, 于慶巍, 等. 植骨技術結合金屬網杯重建髖臼骨缺損在全髖關節置換術中的應用. 中華骨科雜志, 2012, 32(9): 823-829.
2.	葉一林, 朱天岳, 柴衛兵, 等. 混合植骨技術結合髖臼加強杯或鈦網杯重建髖臼嚴重骨缺損. 中華骨科雜志, 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, 黎偉凡, 王華, 等. 異體骨移植在髖關節翻修術中應用的10年隨訪. 中華關節外科雜志(電子版), 2012, 6(4): 523-529.
12.	孫俊英, 蔣建農, 王禹基, 等. 采用超大型臼杯生物學固定行臼杯翻修術. 江蘇醫藥, 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.	張媺, 白鵬程, 江建平, 等. 螺旋型髖臼與壓配型髖臼的臨床應用分析. 中國組織工程研究, 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, 王志巖, 肖玉周, 等. 人工髖關節翻修旋轉中心重建的臨床研究. 中華骨科雜志, 2011, 31(5): 475-480.
18.	周緒光, 李軍偉, 王義生, 等. 精確預測髖臼杯型號的數字X線片放大率測量方法. 中國實用醫刊, 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. 陳偉, 谷長躍, 于慶巍, 等. 植骨技術結合金屬網杯重建髖臼骨缺損在全髖關節置換術中的應用. 中華骨科雜志, 2012, 32(9): 823-829.
2. 葉一林, 朱天岳, 柴衛兵, 等. 混合植骨技術結合髖臼加強杯或鈦網杯重建髖臼嚴重骨缺損. 中華骨科雜志, 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, 黎偉凡, 王華, 等. 異體骨移植在髖關節翻修術中應用的10年隨訪. 中華關節外科雜志(電子版), 2012, 6(4): 523-529.
12. 孫俊英, 蔣建農, 王禹基, 等. 采用超大型臼杯生物學固定行臼杯翻修術. 江蘇醫藥, 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. 張媺, 白鵬程, 江建平, 等. 螺旋型髖臼與壓配型髖臼的臨床應用分析. 中國組織工程研究, 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, 王志巖, 肖玉周, 等. 人工髖關節翻修旋轉中心重建的臨床研究. 中華骨科雜志, 2011, 31(5): 475-480.
18. 周緒光, 李軍偉, 王義生, 等. 精確預測髖臼杯型號的數字X線片放大率測量方法. 中國實用醫刊, 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.

《中國修復重建外科雜志》

加大號生物型臼杯在人工髖關節翻修術中的應用

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《中國修復重建外科雜志》

加大號生物型臼杯在人工髖關節翻修術中的應用

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