大龄中、高位先天性髋脱位全髋置换术方法探讨

Methods of Total Hip Replacement in Treatment of High or Middle Congenital Dislocation of Hip in the Elderly

目的探讨全髋关节置换术治疗大龄中、高位先天性髋脱位的方法。方法1998年1月～2004年12月,对21例27髋大龄中、商位先天性髋关节脱位假臼骨性关节炎病人行全髋关节置换术,其中男1例,女20例,单侧15例,双侧6例,所有病例术前均行髂腰肌和/或部分内收肌群切断加股骨髁上骨牵引15～45 d,平均30 d,所有病人均于真臼位置行全髋置换术。结果术后无1例感染,1例术后1年髋臼松动植骨块部分吸收,行翻修手术,随访4年效果满意；2例术后出现轻度坐骨神经牵拉症状,2个月后症状消失,4例出现下肢深静脉血栓,经溶栓治疗后症状消失；随访6个月～6年疗效满意。结论术前行髂腰肌切断和/或部分内收肌群切断加股骨髁上骨牵引,可以有效地增加肢体长度,避免小转子下股骨截骨术,减少或避免了术后神经、血管的牵拉症状,疗效满意。

Objective To summarize the experiences of total hip replacement in the treatment of high or middle congenital dislocation of hip in the elderly. Methods Between 1998 to 2004, 27 total hip replacements were performed in 21 elderly patients who had painful untreated high or middle congenital dislocation of the hip. Twenty women and one man were included. The dislocation was unilateral in 15 patients and bilateral in 6 patients. The femoral head was positioned in the true acetabulum after preoperative releases of iliopsoas muscle and/or partial adductor muscle in addition to the supracondylar bone traction for 15 up to 45 days （mean, 30 days）. Results The incision healed smoothly. Loosening of the plastic cup was observed in one patient and the revision surgery was performed with the satisfactory result. Sciatic and femoral nerve paralysis was observed in two patients and disappeared in two months. The deep venous thrombosis of leg was observed and healed in four patients. The followed - up period ranged from 6 months to 6 years. All patients had satisfactory results. Conclusion Preoperative release of iliopsoas muscle and/or partial adductor muscle can increase the length of leg and avoid removing a segment of bone below the level of the lesser trochanter. This effectively avoids excessive stretching of the femoral nerve and iliac vessels with satisfactory results.