Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup
Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup
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DOI：
10.1007/s11999-008-0442-x
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发表时间：
2008-10-01
影响因子：
4.2
通讯作者：
Piccaluga, Francisco
中科院分区：
文献类型：
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作者：
Buttaro, Martin A.;Comba, Fernando;Piccaluga, Francisco
在存在节段性和空洞性髋臼缺陷的情况下，植入植骨是有争议的，需要使用补充装置来闭合节段性缺陷。然而，这种方法可以治疗仅靠植入的松质骨不能处理的综合缺陷。我们提出了以下两个问题：(1)用金属网片、嵌入体移植和胶合杯重建联合缺损区的患者的存活率是多少？(2)金属网片能否防止牙杯移位？在髋关节翻修术中，我们评估了23个空洞性非囊性髋臼缺损。术前诊断为无菌性松动(19个髋关节)和感染切除后二期再植入术(4个髋关节)。术前Merle D‘Aubigne-Postel评分平均7.4分。2例患者在术后6个月和24个月因机械故障再次手术。以再次翻修为终点的生存率为90.8%，平均36个月(范围24~56个月；95%可信区间68.1~97.6)。金属网不能阻止杯状移位：所有患者均发生移位，平均5.1 mm(范围2-25 mm)。另有3例合并严重缺损者，无症状网片破裂，移位3~15 mm。术后功能评分平均16.2分。对于中度非包含性髋臼缺损区的重建，应考虑金属网、嵌入性植骨和骨水泥杯，但对于严重的复合性缺损区则不应考虑。
Impaction grafting is controversial in the presence of segmental and cavitary acetabular defects and requires the use of supplemental devices to close segmental defects. This approach, however, would allow treating combined deficiencies that could not be managed with impacted cancellous bone alone. We raised the following two questions: (1) What is the survival rate in patients with combined deficiencies reconstructed with metal mesh, impaction grafting and a cemented cup and (2) can metal mesh prevent cup migration? We evaluated 23 cavitary uncontained acetabular defects in revision hip arthroplasty. Preoperative diagnoses were aseptic loosening (19 hips) and second-stage reimplantations after resection for infection (four hips). The preoperative Merle D'Aubigne-Postel score averaged 7.4 points. Two patients had reoperations for mechanical failure at 6 and 24 months. The survival rate with further revision as an end point was 90.8% at an average of 36 months (range, 24-56 months; 95% confidence interval, 68.1-97.6). Metal mesh did not prevent cup migration: migration occurred in all patients, averaging 5.1 mm (range, 2-25 mm). Another three patients with severe combined defects had asymptomatic mesh rupture with 3- to 15-mm migration. Postoperative functional score averaged 16.2 points. Metal mesh, impaction grafting, and a cemented cup should be considered for reconstruction of medium uncontained acetabular defects, but not for severe combined deficiencies.