RESUMEN
OBJECTIVE:To observe the effectiveness of using Ti-alloy mesh and morcellized cancellous allograft in treatment of acetabular deficiency in revision total hip arthroplasty. METHODS:A total of 31 patients with acetabular defects underwent impaction morsellized cancellous allografting combined with Ti-alloy mesh for the reconstruction of the defected acetabula at the Second Department of Orthopaedics,First Hospital,Jilin University from January 2003 to July 2008. There were 13 males and 18 females,aged from 56-77 years,averagely 65 years. The time from previous surgery to this revision surgery was 2.5-11.0 years,averagely 8.3 years. The defects were classified into various types according to AAOS:type Ⅱ in 14 hips,type Ⅲ in 17 hips. The average pre-operation Harris score were 37 points. Bone cement was used to fix the prosthesis in 31 patients,and clinical evaluation and X-ray assessment were conducted following surgery. RESULTS:Following-up was done in 31 patients for 3 months to 5 years. 24 hours following surgery,passive functional exercises were conducted in the lower limb of patients. At 3 weeks,20 patients could get out of bed,with incompletely loading. Eleven patients got out of bed at 5 weeks following surgery,and did normal activities at 3 months. Harris score elevated averagely 45 points half years following surgery compared with preoperation,including 20 excellent cases,9 good cases,and 2 average cases,resulting in the excellent and good rate of 94%. At 3 months following surgery,no infection,fracture around the prosthesis,dislocation,nerve vessel and pelvic cavity organ damages or embolism were detected. The wound was delayed union,with discontinuous effusion in 3 patients till 3 weeks following surgery. None of these patients needed to be revised again and 2 cases had radiolucent line in radiograph plain film,which indicated that the bone graft might be absorbed. CONCLUSION:The treatment of acetabular defects by Ti-alloy mesh and impaction allograft in hip revision operation is easy and effective method.
RESUMEN
[Objective]To discuss the fractures classification,operative route,internal fixation and operative therapeutic effection of acetabular fractures.[Method]Thirty-four cases of acetabulum fractures and femoral head dislocation were involved from November 2001 to August 2006 in our hospital throught operative treatment.The classification according of AO system:type A fractures 24 cases,type B 10 cases.Applicated Kocher-Langenbeck operative route was applied in 20 cases,Gibson route 2cases,illioinguinal route 4 cases and anteriorcombined posterior route 4 cases.Thirty-two cases were adopted reconstruction plates and screws and 2 cases steel-wire cerclage to fix fracture.All patients were followed up.[Result]Acorrding to evaluation system of AAOS:excellent in 12 cases,good in 12 cases,fair in 4 cases,poor in 6 cases.Total exellence rate were 71%.[Conclusion]Combinate full-scale imageology information,correct classification of fracture according of AO,reasonable surgical approach and fixation,correct subtle technique during the operation and effective fracture resetting are keys to improve the effect of acetabular fractures.