全髋关节置换翻修两种垫块填充髋臼骨缺损比较

Comparison of two augments for acetabular defects in revision total hip arthroplasty

摘要:

[目的] 比较新型半球形钛金属垫块 (hemispheric titanium augment, HTA) 与传统橘瓣形钽金属垫块 (orange sliceshaped tantalum augment, OSTA) 在髋关节翻修髋臼侧重建中的应用的临床效果。[方法] 回顾性分析 2018 年 1 月—2019 年 6 月，在中科大附一院骨科使用垫块重建髋臼的全髋关节翻修术 67 例(67 髋)患者的临床资料，根据医患沟通结果，35 例采用 HTA，32 例使用 OSTA 重建髋臼。比较两组围手术期、随访及影像结果。[结果]两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。HTA 组手术时间、术中出血量均显著优于 OSTA 组 (P＜0.05)。两组切口总长度、下地行走时间、住院时间的差异均无统计学意义 (P＜0.05)。所有患者均获随访 2 年以上。两组完全负重活动时间的差异无统计学意义 (P＜0.05)。 术后随时间推移，两组 Harris 评分、髋伸屈 ROM、VAS 评分均显著改善(P＜0.05)，相应时间点，两组间上述指标的差异均无统计学意义(P＞0.05)。影像方面，两组术后髋臼假体外翻角及前倾角的差异无统计学意义(P＞0.05)，与术前相比，两组术后 LLD、HCOR 横向及纵向偏移均显著减小 (P＜0.05)，相应时间点，两组间上述指标的差异均无统计学意义 (P＞0.05)，[结论] 半球面金属垫块和钽金属垫块的临床和影像学结果相当，但前者手术操作快速便捷。

Abstract:

[Objective] To compare the clinical outcomes of a novel hemispherical titanium augment (HTA) versus traditional orange slice-shaped tantalum augment (OSTA) for acetabular reconstruction in revision total hip arthroplasty (RTHA) . [Methods] A retrospective study was done on 67 patients (67 hips) who received RTHA for previous prosthetic loosening complicated with acetabular bone defect in our department from January 2018 to June 2019. According to the doctor-patient communication, 35 patients had HTA used, while the re- maining 32 patients had OSTA used to reconstruct the acetabulum. The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups had RHTA performed smoothly without injures to nerve and vascular vessel, as well as other serious complications. The HAS group proved significantly superior to the OSTA group in terms of operation time and in- traoperative blood loss (P＜0.05) , although there were no significant differences in the total length of incisions, postoperative walking time and hospital stay between the two groups (P＞0.05) . All the patients were followed up for more than 2 years without a significant difference in the time to resume full weight-bearing activity between the two groups (P＞0.05) . The Harris score, hip extension-flexion ROM and VAS scores significantly improved over time in both groups (P＜0.05) , which were not significantly different between the two groups at any corresponding time points (P＞0.05) . Radiographically, there were no significant differences between the two groups in acetabular inclina- tion and anteversion postoperatively (P＜0.05) . Compared with those preoperatively, postoperative leg length discrepancy (LLD) and hip center of rotation (HCOR) displacement transversely and longitudinally significantly decreased postoperatively in both groups (P＜0.05) , which were not significant different between the two groups at any corresponding time points (P＞0.05) . [Conclusion] Although the clini- cal and imaging consequences are similar between the HTA and OSTA, the former is quick and convenient in term of operation manipula- tion over the latter.