髋关节表面置换术治疗先天性髋关节发育不良

Hip resurfacing arthroplasty for secondary osteoarthritis after developmental dysplasia of hip

目的探讨髋关节表面置换术治疗先天性髋关节发育不良的临床疗效。方法2005年3月至2006年12月对34例（37髋）先天性髋关节发育不良患者行髋关节表面置换术，其中CroweⅠ型28例（31髋）、CroweⅡ型6例（6髋）。其中女性29例（32髋），男性5例（5髋），患者平均年龄45岁（26～57岁）。患者在术后6周、3个月、1年，及此后每年1次进行随访，接受放射学及临床评价。术前患者Harris评分平均35分，髋关节屈曲101°，外展24°，内收15°，术前12例患者双下肢等长。结果34例患者中，3例（3髋）患者术中改行全髋关节置换术。31例（34髋）行表面置换。31例表面置换患者平均随访时间21．4个月（12～33个月）。患者术后最后一次随访平均为94分（82～100分），与术前比较差异具有统计学意义（P〈0.01）。术后髋关节屈曲改善至133°，外展48°，内收26°。术后23例患者双下肢等长。患者股骨及髋臼假体周围均未见透亮线，髋臼假体的平均外展角为43°（40°～53°），股骨假体柄干角平均为139°（130°～145°）。结论本组患者短期随访结果令人满意，良好的手术技术和手术适应证的严格掌握是先天性髋关节发育不良患者手术成功的关键。

Objective To study the clinical results of metal on metal hip resurfacing arthroplasty for developmental dysplasia patients. Methods From March 2005 to December 2006, 34 cases of developmental dysplasia patients （ Crowe Ⅰ , Crowe Ⅱ ） were attempted to have metal on metal hip resurfacing arthroplasty. There were 29 females （32 hips）, 5 males （5 hips）. The average age was 45 （26- 57） years old. Radiographic and clinical evaluations were taken at 6 weeks, 3 months, 1 year and then once a year postoperatively. The average Harris score was 35 （25-44）. Hip flexion was 101°, abduction 24°, adduction 15°. Results Three patients were turned to total hip arthroplasty during operations. Thirty-one patients （34 hips） received hip resurfacing surgery. These 31 patients were followed for average 21.4 months （12-33 months）. The average Harris score was 94 （82-100） at the latest follow-up, and there was statistical difference compared with the preoperative score （P 〈 0. 01 ）. Hip flexion increased to 133~, abduction to 48°, adduction to 26°. No radiolucency line was found at both acetabular and femoral sides in all the patients. The average abduction angle of acetabular cup was 43°（40°-53°） , and the average stem shaft angle was 139°（130°-145°）. Conclusions The short term result is excellent. While the mid to long term results for hip resurfacing arthroplasty in developmental dysplasia patients are still looking forward, and the meticulous surgical technique and strict patient selection are the key of the good results.