全髋关节置换治疗髋关节发育不全

Total Hip Arthroplasty for Developmental Dysplasia of the Hip

目的：研究全髋关节置换治疗髋关节发育不全（ＤＤＨ）的外科技术。方法：４７例（５４髋）因髋关节发育不全引起严重骨性关节炎的患者行全髋关节置换治疗，其中男８例，女３９例。随访１２个月～１４年，平均５３个月。结果：根据ＭｅｒｌｅＤ＇Ａｕｂｉｇｎｅ评分方法，优８例（１７～１８分）、良３０例（１３～１６分）、中８例（９～１２分）、差１例（＜８分）。结论：根据髋关节脱位的程度可将髋关节发育不全分成四度，其中Ⅰ度、Ⅱ度为半脱位型；Ⅲ度、Ⅳ度为全脱位型。ＤＤＨⅠ度，即低位半脱位，髋臼加深为其手术要点；ＤＤＨⅡ度，即高位半脱位，通过上移髋臼假体可以避免植骨；对于ＤＤＨⅢ度、Ⅳ度则使用小型髋臼假体并且植骨。我们提出的分类方法较Ｃｒｏｗｅ方法简便且实用，特别是对髋臼的处理有指导意义。对髋关节发育不全进行全髋关节置换应严格掌握适应证。

Objective: To study the surgical technique of total hip arthroplasty (THA) for developmental dysplasia of hip joint (DDH). Methods: 54 hips of 47 patients with advanced osteoarthritis secondary to DDH undergone THA were reviewed. The mean follow up peroid was 53 months (range 12 months to 14 years). Results: Based on Merle D' Aubigne evaluation method, all the patients but one showed marked improvement. Conclusion: DDH can be divided into four degrees according to the extent of subluxation or dislocation of hip joints. DegreeⅠand Ⅱpresent as subluxation, while degree Ⅲand Ⅳas dislocation. Deepening the medial wall of acetabulum is the main point of operation for degree Ⅰ(low subluxation). For degree Ⅱ(high subluxation), bone graft can be avoided by high placement of acetabular component. Small acetabular component and bone graft is necessary for degree Ⅲand Ⅳ(dislocation). The classification method proposed by the authors is easier and more useful than the Crowe's method. The indication of THA for DDH should be strict.