CroweⅢ及Ⅳ型髋关节发育不良全髋关节置换术的软组织松解与平衡探讨

Release and balance of the soft tissue in total hip arthroplasty for patients with Crowe Ⅲ and Ⅳ type developmental dysplasia of hip

目的探讨分步髋周软组织松解与平衡重建髋臼后,行全髋关节置换术(THA)治疗成人 Crowe Ⅲ～Ⅳ型髋关节发育不良的效果。方法 2001年1月至2006年1月,对29例(31髋)CroweⅢ～Ⅳ型成人髋关节发育不良患者行 THA,其中男性7例,女性22例,患者平均年龄53岁(38～65岁)。Crowe Ⅲ型22髋,Ⅳ型9髋,Harris 评分术前平均42.6分。全部患者均为手术外侧入路,采用分步髋周软组织松解延长患肢,真臼位置重建髋臼后,行 THA。结果患肢延长2.5～4.5 cm,1例因髋臼外展角稍大出现术后脱位。29例患者术后随访1～5年,平均3.2年。Harris 评分术后平均85.4分,关节疼痛缓解,活动功能满意,无假体松动和翻修病例。结论在重度髋关节发育不良 THA 中,通过有效的软组织松解和平衡,在真臼位置重建关节,可以最大程度地恢复患髋解剖形态和生理功能。

Objective To summarize the surgical experience of release and balance of soft tissues around hip in total hip arthroplasty for patients with severe hip dysplasia. Methods From January 2001 to January 2006, 29 patients （3 lhips） of adult dysplastia of hip were included in the study. Among them, there were 22 females and 7 males, age from 38 to 65 years with average of 53 years. According to Crowe classification system, there were 22 in type Ⅲ, 9 in type Ⅳ, and Harris score was 42. 6 preoperatively. Total hip arthroplasty was performed via lateral approach. All the acetabular cups were reconstructed at the original anatomic location through release of soft tissue around hip to restore limb length, and techniques of balance of soft tissue were applied to extend force ann of hip abductor and improve its function. Results All the patients had restoration of limb length （ ranged from 2. 5 cm to 4. 5 cm）. One case of postoperative dislocation was occurred due to slight large of acetabular abduce angle. Follow-up for 1-5 years （ average 3. 2 years） in 29 patients, the Harris score increased to 85.4 postoperatively. All hips had released from pain and functioned well. Conclusions In order to restoration anatomic structure and physiologic function of affected hip, the technique of release and balance of soft tissues around hip should be applied and cautioned in arthroplasty of dysplastic hip.