Acetabular Reconstruction with Reinforcement Ring and Morsellised Graft: Technique and Medium-term Result: 以髖臼加強環及切碎骨來重建髖臼 - 技術及中期結果

BackgroundAcetabular bone defects are commonly seen in both primary and secondary total hip arthroplasty, creating difficulties in restoring anatomical hip centres, which results in high mechanical failure rate.MethodsTotal hip arthroplasty with acetabular reinforcement rings were performed in 18 hips in 18 patients from 1996 to 2011 in United Christian Hospital. Both clinical and radiographical assessment were performed during follow-up.ResultsEight patients died of unrelated diseases with average follow-up of 30.5 months. At the latest follow-up, none of them showed radiographic signs of loosening or migration of implants and none of them required revision surgery. The remaining 10 patients with mean age of 77.9 years (range, 65–88) at the time of operation were followed-up for an average of 67.4 months (range, 11–121). The average Harris hip score was 78.3 (range, 58.5–87). The average vertical and horizontal difference of hip centres was 1.5 mm superiorly (p = 0.431) and 0.4 mm medially (p = 0.619) respectively when postoperative hip centres were compared to their contralateral hips. The average inclination of the polyethylene cup was 47.8 degrees (range, 42–58). There was no evidence of radiographic loosening during our follow-up and none of them required revision surgery.ConclusionAcetabular reconstruction with the use of acetabular reinforcement rings and morsellised bone grafts showed satisfactory clinical and radiographic results at a medium-term follow-up.

中 文 摘 要背景髖臼骨缺損常見於初次及翻修全髖關節置換術，使重建髖關節中心困難，導致較高的機械性失敗率。方法在1996 年至2011 年間，基督教聯合醫院共進行了18 例使用髖臼加強環的全髖關節置換術。隨訪期間我們以臨床和X 光片進行評估。結果共8 例死於無關的疾病，其平均隨訪時間為30.5 個月。他們沒有表現出鬆動或遷移的跡象，亦沒有需要進行翻修手術。其餘10 例隨訪時間平均67.4 個月（範圍11-121），平均年齡為77.9 歲（範圍65-88）。 Harris 評分平均為78.3（範圍58.5–87）。相對於對側的髖關節，術後的髖關節中心的平均垂直和水平的差異分別為上方1.5 毫米（p = 0.431）和內側0.4 毫米（p = 0.619）。聚乙烯杯中的平均傾角為47.8 度（範圍42–58）。隨訪期間他們沒有表現出鬆動的跡象，亦沒有需要進行翻修手術。結論於全髖關節置換術使用髖臼加強環和切碎骨來重建髖骨在這中期研究中展現出滿意的臨床和影像學結果。