髋关节发育不良继发骨关节炎患者的人工全髋关节置换

Total hip arthroplasty for patients with osteoarthritis secondary to hip developmental dysplasia

目的探讨髋关节发育不良继发骨关节炎患者的全髋关节置换术中,恢复正常髋臼旋转中心高度和下肢长度的方法.方法 2000年1月至2003年1月, 对21例(26髋)髋关节发育不良继发骨关节炎患者施行了全髋关节置换术.女性19例, 男性2例, 平均年龄51岁(40～66岁).根据Crowe X线分型,Ⅰ型12例Ⅱ型5例Ⅲ型和Ⅳ型各 2例. 髋臼旋转中心的重建方法包括标准的全髋关节置换术、结构性自体植骨和髋臼旋转中心内移. 恢复下肢长度的方法包括详细的术前计划、术中彻底切除挛缩的关节囊和纤维疤痕组织并酌情进行软组织松解.术后第3、6、12个月及之后每年门诊随访,随访内容包括:(1) X线测量双下肢长度差和髋臼旋转中心位置; (2) Harris评分进行髋关节功能评价.结果所有病例髋臼旋转中心都恢复正常,髋臼旋转中心恢复的方法包括:⑴常规方法13例(Ⅰ型12例,Ⅱ1例);(2) 结构性植骨6例(Ⅱ型4例,Ⅲ型2例);(3) 髋臼旋转中心内移3例(Ⅲ型1例,Ⅳ2例).术前双下肢长度差为2.0～6.5 cm,术后双下肢长度差为0～1 cm.所有病例平均随访 26.4个月(12～48个月), 至最后随访时, Harris评分由术前的平均35分(12～68分)升高至94分(74～100分).结论髋关节发育不良的全髋关节置换术中, 除了标准的髋臼重建方法之外, 结构性植骨和髋臼旋转中心内移可有效恢复髋臼旋转中心的高度; 术前详细的计划,术中彻底切除挛缩的关节囊和纤维疤痕组织并酌情进行软组织松解有助于恢复下肢长度.

Objective To investigate the methods of restoring normal level of rotation center of the hip and limb length in patients with osteoarthritis(OA) secondary to developmental dysplasia of the hip(DDH) using total hip arthroplasty(THA). Methods From January 2000 to January 2003, total hip arthroplasties were performed for 21 patients (26 hips) with OA secondary to DDH. There were 19 females and 2 males with an average age of 51 years (range from 40 to 66 years). Based on radiographic classification of Crowe, there were 12 in type Ⅰ,5 in type Ⅱ,2 in type Ⅲ and Ⅳ respectively. In addition to the standard procedure of THA, the methods of restoring normal level of rotating center of the hip included structural bone autografting and medialization of the cup. The methods of limb length restoration included carefully preoperative planning and intraoperative soft tissue release. During the follow-up period at 3, 6, 12 months postoperatively and then annually thereafter, rotation center of the hip and limb length were assessed radiographically. Harris score system (HSS) was used for clinical evaluation. Results All the patients were followed up for a mean time of 26.4 months (range from 12 to 48 months). All the patients had restoration of the normal level of rotation center of the hip. At the latest follow-up, Harris score was improved from preoperative 35 points (range from 12 to 68 points) to postoperative 94 points (range from 74 to 100 points). Conclusion In addition to standard procedure, the restoration of normal level of rotation center of the hip could be achieved by structural bone autografting and medialization of the cup in THA for patients with DDH. Careful preoperative planning and intraoperative soft tissue release could restore limb length.