全髋关节置换术治疗成人CroweⅣ型先天性髋关节脱位的临床研究

Total hip arthroplasty for Crowe type-Ⅳ development dysplasia of hip in adults

目的探讨 Crowe Ⅳ型先天性髋关节脱位患者全髋关节置换术的手术方法及预防神经损伤的对策。方法 35例(39髋)Crowe Ⅳ型先天性髋关节脱位患者行全髋关节置换术,均为女性,年龄36～56岁,平均46岁。获得随访31例35髋,随访时间1年～8年,平均4年。手术采用后外侧切口。髋臼侧除1例2髋外,均在真臼水平安放臼杯并使用非骨水泥型假体,股骨侧5例5髋选用骨水泥型假体,其余均选用非骨水泥型假体。2例2髋以往曾行转子下截骨者先行转子下截骨矫正术,再植入非骨水泥型假体。采用髋关节功能评分(Harris 评分)评定髋关节功能,术前平均43分。结果获得随访的31例(35髋)中,5例5髋发生术中骨折,其中小转子轻微襞裂骨折3例3髋,大转子不全骨折2例2髋,但股骨假体稳定,予钢丝固定或未作特殊处理。3髋发生异位骨化,均为 BrookⅡ型。2例术后分别出现坐骨神经或股神经刺激症状,1个月后恢复正常。随访期间内无一例发生术后感染、术中术后髋关节脱位、假体松动及有明显临床表现的深静脉血栓形成等并发症。术后随访时Harris 评分平均87分,术后肢体延长4～6 cm,平均5 cm,肢体短缩得到满意纠正。结论后外侧入路、真臼水平重建髋臼是 Crowe Ⅳ型先天性髋关节脱位全髋关节置换术安全、有效的手术方法。

Objective To determine the operation procedure of total hip arthroplasty （THA） for Crowe type-Ⅳ developmental dysplasia of hip and its relationship with nerve injury. Methods A consecutive series of 39 THAs was performed for Crowe type-Ⅳ developmental dysplasia of hip in 35 patients （all female）. The mean age of the patients at the time of surgery was 46 years （range 36-56years）. Thirtyfive hips in 31 patients were followed up. The average follow-up period of the whole series was 4 years （range 1-8 years）. All procedures were carried out through a lateral-posterior approach. In 33 of 35 hips, the cup was inserted in the ＂true＂ acetabulum. All the prostheses used were cementless, except for 5 cemented femoral stems in 5 patients. Each patient was evaluated clinically and by radiographs before the operation and during the follow-up period, according to the Harris hip score （HHS）. Results None of the cups and stems were revised for aseptic loosening, dislocation or infection during the follow-up period. The mean preoperative HHS was 43 compared with the postoperative HH5 of 87. The mean amount of postoperative leg lengthening was 5 cm（ range 4-6 cm ）. Conclusions The reconstruction of the hip at the level of the ＂true＂ acetabulum through a lateral-posterior approach is a safe and effective procedure of THA for Crowe type-Ⅳ developmental dysplasia of hip in adults. Acute leg lengthening of less than 6 cm could not cause nerve injury.