发育性髋关节结构不良患者的全髋关节置换术

Total hip arthroplasty for developmental dysplasia of hip

目的成人发育性髋关节结构不良继发骨关节炎症状严重时常需行全髋关节置换术.本研究针对髋臼和股骨侧重建以及假体选择等几个方面对不同Crowe分级的发育性髋关节结构不良患者行全髋关节置换术的疗效进行评价.方法 2003年8月～2004年10月我院对37例(39髋)发育性髋关节结构不良继发骨关节炎的患者施行全髋关节置换术,女35例,男2例;年龄44～79岁.按照Crowe分级:Ⅰ级16髋,Ⅱ级7髋,Ⅲ级8髋,Ⅳ级8髋.对CroweⅠ～Ⅲ级患者选用普通的生物型假体或Hybrid假体.对8例高位脱位的CroweⅣ级患者,髋臼侧选用骨水泥假体1例、小髋臼生物型假体5例(其中1例采用髋臼内移技术)、普通生物型髋臼2例,股骨侧选用生物型假体2例、普通骨水泥假体4例、长柄骨水泥假体柄1例、S-ROM假体1例.有8例劈大粗隆行钢丝或大粗隆再连接装置和钢缆固定.结果 CroweⅠ～Ⅲ级的患者术后拔除引流管即可下床活动进行功能锻炼.高位脱位的8例CroweⅣ级患者中1例采用髋臼内移技术;1例采用粗隆下去旋转截骨,术后卧床3个月后进行功能锻炼;劈大粗隆行钢丝或大粗隆再连接装置和钢缆固定的患者术后3周下床活动,2例术后出现股神经麻痹,3个月后恢复.结论发育性髋关节结构不良的患者髋臼和股骨均存在解剖异常;对于高位脱位的CroweⅣ级患者髋臼侧可选用小髋臼生物型假体或采用髋臼内移技术,股骨侧可选用横径较细的直柄或短柄假体.短缩>4 cm的患者除软组织松解外还可考虑粗隆下去旋转截骨.

Objective It is generally agreed that total hip arthroplasty be performed for severe degenerative arthritis secondary to developmental dysplasia of hip. This study evaluated the total hip arthroplasty performed for the four Crowe classification types with regard to acetabular and femoral reconstruction as well as prosthetic selection.Methods Between Aug 2003 to Oct 2004, 39 total hip arthroplasties in 37 patients with osteoarthritis secondary to developmental dysplasia were performed in our hospital (35 women and 2 men). The age at the time of operation was between 44 to 79 years old. According to Crowe classsification, 16 procedures were performed in Crowe type-Ⅰ, 7 in Crowe type-Ⅱ, 8 in Crowe type-Ⅲ and 8 in Crowe type-Ⅳ. Cementless total hip arthroplasty or hybrid technique were applied in patients with Crowe type-Ⅰ, Ⅱ and Crowe type-Ⅲ . Among 8 patients with Crowe type-Ⅳ, the acetabular reconstruction was done with the cemented acetabular component in 1 patient, the small acetabular component in 5 patients (acetabuloplasty in 1 patient) and common cementless acetabular component in 2 patients. Cementless shaft was used in 2 patients, common cemented shaft in 4, long cemented shaft in 1 and S-ROM prosthesis in 1. Greater trochanteric osteotomy was performed in 8 patients followed by greater trochanter reattachment device or wire fixation.Results Early mobilization was encouraged in patients with Crowe type-Ⅰ, Ⅱ and to Crowe type-Ⅲ after removal of drainage sac. 3 months bed rest was recommended in patients with acetabuloplasty or shortened derotation osteotomy. The patients performed with greater trochanter osteotomy were encouraged to be out of bed at 3 weeks postoperatively. There were 2 postoperative femoral nerve palsy resolving completely within 3 months.Conclusion Total hip arthroplasty for the treatment of developmental dysplasia of hip is difficult because of the associated anatomical abnormalities, acetabuloplasty can be performed and an appropriate femoral implant can be used in the narrow hypoplastic femoral diaphysis. A shortened derotation osteotomy must be performed in patients with a leg lengthening more than 4 cm.