髋臼内壁截骨术在发育不良髋关节全髋置换髋臼重建中的应用

Cotyloidplasty in acetabular reconstruction for dysplastic hips

目的探讨髋臼内壁截骨术在发育不良髋关节髋臼重建中的应用。方法2001年5月至2002年12月,采用结合髋臼内壁截骨术的全髋关节置换术治疗髋关节发育不良患者17例18髋,男1例1髋,女16例17髋,年龄35～70岁,平均51.4岁。其中CroweⅠ期4髋,Ⅱ期7髋,Ⅲ期4髋,Ⅳ期3髋。通过在手术前、后X线片上绘制Ranawat三角,对照手术前、后髋关节旋转中心与理想旋转中心的距离,测量术后臼杯穹顶与Kohler线的距离、臼杯直径等研究髋关节旋转中心重建与臼杯固定的效果。结果所有人工臼杯均安置于真臼位置,臼杯直径44～56mm,平均50.78mm。术前股骨头中心距理想旋转中心水平距离为12～40mm,平均21.09mm;术后股骨头中心距理想旋转中心水平距离为-3～10.1mm,平均3.73mm;手术前、后比较差异有统计学意义(t=7.95,P<0.01)。术前股骨头中心距理想旋转中心垂直距离为5～32mm,平均15.39mm;术后股骨头中心距理想旋转中心垂直距离为-18～26.3m m,平均4.98mm;手术前、后比较差异有统计学意义(t=3.42,P<0.01)。随访3个月以上者,截骨部位均骨性愈合。结论内壁截骨术有助于将发育不良髋关节的髋臼安置于真臼位置,保留髋臼底部的骨量,避免髋臼外上方植骨的并发症。

O bjective To introducetheosteotomyofacetabularmedialwallas a techniqueto facilitateanatomicalimplantationand securefitofacetabularcupsfordysplastichips. Methods Eighteen hipreplacementswereperformedwithuseofan osteotomyofacetabularmedialwalltostabilizethecups in 17 dysplasticpatients. The patientswere aged from35-70 years, withan averageof51.4 year. Among all thedysplastichips,4 were oftypeⅠ,7 oftypeⅡ,4 oftypeⅢ,and 3 oftypeⅣ accordingtotheCrowe criteria. A Ranawat trianglewas drawn on theX-ray film, and a supposedoptimalrotatingcenterwas located.Bothofthehorizontaland verticaldistancesbetweenfemoralhead and supposedrotatingcenterwas decreasedsignificantlyafteroperation.Results With medialwallosteotomy,alltheacetabularcomponents wereplacedinthetrueacetabulum.The diametersoftheimplantedcupswere44-56 mm withan averageof 50.78 mm . Medialbony wallwas preservedwithan averagethicknessof9.5 mm . The horizontaldistance was 21.09 mm (12-40 mm )preoperativelyand 3.73 mm (-3-10.1 mm )postoperatively,therewas statistical difference(t=7.95,P< 0.01);whereastheverticaldistancewas 15.39 mm (5-32 mm )preoperativelyand 4.98 mm (-18-26.3 mm ) postoperatively, therewas alsostatisticaldifference(t=3.42, P< 0.01). 13 acetabular cupswereimplantedwiththemedialaspectoftheirdome beyondtheKohlerline. Inthecasesfollowed-up more than3 months,theosteomizedsiteallachievedbony union. Conclusion The medialwallosteotomy techniqueisa predictable, reproducibleprocedureforoptimalrotatingcenterreconstructionand itmay obtainfixationofan uncementedhemisphericacetabularcomponentina dysplastichip.