ACETABULAR RECONSTRUCTION IN PAPROSKY TYPE III DEFECTS

ABSTRACT Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.

摘要 目的：重度骨盆缺损是髋关节置换术中的棘手难题。具体手术目标为恢复骨盆骨量、将髋臼假体置入正确解剖位置，并优化关节稳定性。目前针对髋臼复杂缺损的假体翻修手术已开发出多种外科技术，但尚未就最佳治疗方案达成共识。本研究旨在回顾分析采用同种异体骨植骨结合Bursch-Schneider环形防突出Cage（BSAC）治疗的重度骨缺损（Paprosky Ⅲ型）患者的中期病例。方法：本研究为回顾性连续病例系列分析，纳入2006年至2011年间完成的首批23例复杂髋臼重建手术病例，涵盖该术式的学习曲线阶段，且随访时长至少5年。结论：本研究证实，冷冻颗粒状同种异体骨联合金属环形BSAC用于髋臼重建的方案具有有效性。若要获得长期手术成功，必须恢复髋关节旋转中心的解剖位置。对于大范围假体松动病例，唯有通过环形支架保护下的植骨进行骨密度重建，方可恢复解剖旋转中心，进而改善股骨头的对中效果。证据等级：Ⅳ级，病例系列研究。