全髋置换治疗CroweⅡ/Ⅲ型髋关节发育不良的髋臼解剖重建方法及疗效

doi:10.3877/cma.j.issn.1674-134X.2018.04.005

目的

探讨在全髋关节置换术治疗Crowe Ⅱ/Ⅲ型成人髋关节发育不良(DDH)继发骨关节炎(OA)中髋臼侧解剖重建及髋臼假体外上方骨缺损的处理方法与疗效。

方法

回顾性分析2012年1月至2016年12月期间，在南通大学附属建湖医院骨科进行人工全髋关节置换术治疗的38例。病例纳入标准为Crowe Ⅱ/Ⅲ型成人DDH继发终末期骨关节炎，髋关节疼痛影响正常行走功能；排除标准为患髋有感染史、骨折史、手术史，以及患肢合并其他疾病。术前、术后对术侧髋关节进行Harris髋关节评分(HHS)，测量比较术前术后髋关节旋转中心的垂直与水平距离。HHS评分、手术前后髋关节旋转中心的水平距离及垂直距离的比较采用配对样本t检验。

结果

所有患者均未发生血管、神经损伤、感染及假体松动，术前患肢平均短缩(2.6±0.7)cm，术后下肢平均延长(2.5±0.4) cm, HHS术前为(37±8)分(25～55分)，术后末次随访(93±4)分(89～100分)，术后HHS较术前明显增高，差异有统计学意义(t＝39.45，P<0.05)，优良率为100%。手术前后骨盆正位X线摄片髋关节旋转中心对比：髋关节旋转中心垂直距离术前(36.7±6.1)mm，术后(13±4)mm，手术前后相比差异有统计学意义(t＝4.28，P<0.05)。髋关节旋转中心水平距离术前(41±7)mm，术后(23±5)mm，手术前后相比差异有统计学意义(t＝4.13，P<0.05)。

结论

全髋关节置换术治疗Crowe Ⅱ/Ⅲ型成人DDH时，髋臼侧解剖重建，髋臼假体外上方骨缺损处骨泥植骨，可取得良好的手术效果。

关键词: 髋脱位, 骨关节炎, 髋, 关节成形术

Objective

To study the method and effect of the treatment of bone defects above the acetabular prosthesis and anatomic reconstruction of acetabulum in total hip replacement for developmental dysplasia of the hip (DDH) of Crowe typeⅡ/Ⅲwith secondary osteoarthritis (OA).

Methods

A retrospective analysis was carried out in 38 patients of CroweⅡ/Ⅲ DDH who had secondary osteoarthritis and underwent total hip replacement, from January 2012 to December 2016 in Nantong University Affiliated JianHu Orthopaedic Hospital. Inclusion criteria: Crowe Ⅱ/Ⅲ adult DDH secondary end stage osteoarthritis, hip pain affects normal walking function; exclusion criteria: history of infection, fracture and operation, and other diseases of the affected limb. Harris hip score (HHS) was used for evaluation before and after the operation, The vertical and horizontal distances of hip rotation center before and after the operation were measured and compared. HHS score, the horizontal distance and the vertical distance of the hip rotation center before and after the operation were compared by paired sample t test.

Results

None of the patient had blood vessel or nerve injury, infection, nor prosthesis loosening. The preoperative limb shortening was (2.6±0.7) cm on average, postoperative lower limb lengthening was (2.5±0.4) cm on average. The preoperative HHS score was (37±8) (25~55), and it was (93±4) (89~100)at the end of the follow-up; the postoperative HHS score was significantly higher than the preoperative one (t =39.45, P<0.05); the fine rate was 100%. The anteroposterior pelvis X-ray of hip joint rotation center before and after the operation showed: preoperative hip rotation center vertical distance was (36.7±6.1) mm, postoperative one was (13±4) mm, the difference was statistically significant (t=4.28, P<0.05). Hip rotation center horizontal distance was (41±7) mm preoperatively, and it was (23±5) mm postoperatively, the difference was statistically significant (t=4.13, P<0.05).

Conclusion

Good results can be obtained by anatomical reconstruction of the acetabulum and bone graft at the bone defect above the acetabulum when treating adult DDH of Crowe type Ⅱ/Ⅲ by total hip arthroplasty.

Key words: Hip dislocation, Osteoarthritis, Hip, Arthroplasty

表1 手术前后HSS评分、旋转中心垂直水平距离对比[n＝38，(±s)]

?	HSS评分(分)	旋转中心垂直距(mm)	旋转中心水平距离(mm)
术前	37±8	37±6	41±7
术后末次随访	93±4	13±4	23±5
t值	39.45	4.28	4.13
P值	<0.05	<0.05	<0.05

表1 手术前后HSS评分、旋转中心垂直水平距离对比[n＝38，(±s)]

?	HSS评分(分)	旋转中心垂直距(mm)	旋转中心水平距离(mm)
术前	37±8	37±6	41±7
术后末次随访	93±4	13±4	23±5
t值	39.45	4.28	4.13
P值	<0.05	<0.05	<0.05

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Method and curative effect of acetabulum reconstruction by total hip arthroplasty in treatment of developmental dysplasia of hip of Crowe typeⅡ/Ⅲ

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Method and curative effect of acetabulum reconstruction by total hip arthroplasty in treatment of developmental dysplasia of hip of Crowe typeⅡ/Ⅲ