单纯髋臼前后缘发育不良的解剖学与临床研究

A study of simple anterior or posterior acetabular wall dysplasia and its clinical significance

目的:探讨单纯髋臼前后缘发育不良对髋周结构的影响及治疗。方法:对1995～2006年收治的18例单纯髋臼前后缘发育不良患者的髋臼形态、临床诊断与治疗进行回顾性调查;根据Harris评分进行临床评价,Ficat分期改变进行影像学评价。结果:髋臼前后缘发育不良相应的髋臼断面角(ASA)及髋臼前倾角AcAVA改变,而中心边缘角(CE角)及髋臼角均正常;采用髋臼加深联合带旋股外侧血管大转子骨瓣移植修复重建股骨头及髋臼2例,全髋关节置换16例。术后临床随访平均4.6年,Harris评分由51.2分改善到89.6分。临床疗效优良率94%。结论:单纯髋臼前后缘发育不良可导致骨关节炎甚至股骨头坏死改变;选择合理的治疗方式如加深髋臼及调整假体安装位置及角度,可以重建髋臼和恢复股骨近端解剖结构及生物力学关系。

Objective： To investigate the effect of simple anterior or posterior acetabular wall dysplasia on the hip joint structure and their treatments. Methods：The clinical dignosis, ,imageology characters, and therapeutic efficacy of 18 cases of patients who inflicted by simple anterior or posterior acetabular wall dysplasia were investigated retrospectively from 1995 to 2006. and then clinical jugement were made based on the Harris score and iconography judgement based on the Ficat classification. Results：All the patients were accompanied with coxarthritis or osteonecrosis of femur head. AASA and AcAVA changed with their relative simple anterior or posterior acetabular wall dysplasia, but the angulus acetabularis and CE angle were normal. There were 2 cases of and 16 cases THR with randomly follow-up clinical investigaiton for average 4.6 yeas. Harris score improved from 51.2 score （43-67）to 89.6 score （82-100）,effective rate could reach to 94%. Conclusions：Simple anterior or posterior a.cetabular wall dysplasia can lead to coxarthritis or even the osteonecrosis of femur head. The rational treatment, for example deepen the acetabular bone or adjust the positon and the attitude of prostheis ,can reconstruct the acetabular bone and .rebuild the anatomic feathers and bio-mechanic relationship between the acetabular and femur head.