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Bone Regeneration and Repair - part 8

Không có trường hợp di chuyển ổ cắm. Steihl et al. (72) báo cáo về xây dựng lại mười bảy sửa đổi phức tạp cho mất xương hoặc cavitary và phân đoạn hoặc gián đoạn xương chậu. Tái tạo Acetabular được thực hiện với allografts đầu xương đùi | Bone Grafting for Total Joint Arthroplasty 275 5 yr follow-up all grafts had healed and mild to moderate resorption was noted for 11 of the 16 hips. There were no cases of socket migration. Steihl et al. 72 reported on the reconstructions of seventeen complex revisions for either cavitary and segmental bone loss or for pelvic discontinuity. Acetabular reconstructions were performed with femoral head allografts posterior segmental acetabular allografts or whole acetabular allografts. Anterior and posterior column plating was used to stabilize the grafts. Sockets were reconstructed with cemented cups in 10 hips and were uncemented in 7 hips. At an average follow-up of almost 7 yr there were two allograft nonunions and a revision rate of 47 . There were two infections requiring resection arthroplasty. A higher failure rate was seen for uncemented cups placed against bulk allograft bone than was seen for the cemented cups. These reconstructions represent the more difficult scenarios faced and the results demonstrate the limitations of minimally protected bulk allograft bone in complex revision surgery. Because large bulk allografts may be prone to fatigue failure using a reinforcement device to protect these grafts from overloading has been advocated. Two main types of acetabular augmentation devices have been described in the literature rings screwed to the ileum alone e.g. the Muller ring and cages that span the acetabulum and are fixed to both the ileum and the ischium e.g. the Burch-Schneider antiprotrusio cage . Several papers have reported satisfactory short-term results with the Muller acetabular reinforcement ring MARR 73 74 . However longer-term analyses demonstrated a higher failure rate 75 and it appears that unless sufficient contact is achieved with the remaining host bone the ring cannot provide a stable and durable construct. Burch-Schneider-type antiprotrusio cages with a superior flange resting against the ileum and an inferior flange that is screwed .