髋关节发育不良人工全髋关节置换57例报告

The Development Dysplasia of Hip in Adult With Acetabuplasty and Total Hip Replacement

目的 探讨髋关节发育不良成人患者的人工全髋关节置换方法和疗效。方法 根据半脱位或脱位程度,分为半脱位型(15例)、半脱位容积宽大型(39例)和完全脱位型(3例),采用加深髋臼,或自体植骨于髋臼缘10～3点钟位,以加深髋臼重建臼顶部和后柱后壁的5项要点,正确安置骨水泥型假体与生物型假体,是使57例71髋接受人工全髋假体置换成功的基础。结果 对57例71髋的髋关节发育不良病人术后经平均5年4个月随访,植入骨愈合,关节功能采用Harris评分,优(>90)44例54髓,良(80～89)10例13髋,可(70～79)3例4髋,无差(<70)者,优良率为94.7％。术后有9例并发症,且均已治愈或改善。结论 成人髋关节发育不良须进一步认识解剖和临床特点,按分型,加深髋臼或/和自体植骨重建髋臼的顶部和后柱,是使人工全髋关节成功置换和提高疗效的关键。

Objective To study on the methods and results of autobonegrafting aeetbuplasty and total hip replacement for development dysplasia of hip in adult. Methods According to the extent of subluxation or dislocation of the hip joints. DDH be divided into subluxation Ⅰ type(15 cases),sublation Ⅱ type(39cases)and dislocation type(3 cases) The acetabulums were deepen with autobonegrafting to the acetabular roof and posterior column and wall for correct direct from ten to three o'clock on the edge of the acetabulum and other five tiles. Since 1994 to July 2003,57 cases(seventy-one hips) with DDH in adult were treated with the total hip prosthesis. Results 57 cases(71 hips)were follow-up, the term of follow-up was mean five years and four monthes. The age of patients was range from 29 to 74.5 years old(average 49.7 years old ).The hip functions with Harris score was excellent(>90)in 44 cases(54 hips)(77.2%),good(80～90) in 10 cases(13 hips)(17.5%),fair(70～79) in 2 cases(3 hips)(3.5%),no poor(<70).The rate of excellent and good is 96.4 percent. The autobonegrafting were health cure. The complications in 9 patients were treatment and most of them were recovered health conditions. Conclusion It be reaware of antomylogy and clinical symptoms on DDH in correctly. According to the type classificatied, the keys were autobonegrafting on the edge of the acetabulum which was deepen for reconstructing the acetabular roof and posterior column and wall. The result of the DDH with total hip replacement would be rised.