成人髋关节发育不良全髋置换术探讨

Total Hip Arthroplasty in Adult Patients with Developmental Dysplasia of the Hip

目的探讨成人髋关节发育不良(developmental dysplasia of hip,DDH)全髋关节置换术的临床方法与疗效。方法1995年1月至2007年6月对成人DDH施行全髋关节置换术39例42髋,男性3例3髋,女性36例39髋,平均年龄51岁(41～67岁)。其中Crowe～型32例33髋,Crowe型6例8髋,Crowe～型1例1髋。采用常规髋关节置换术,恢复髋关节旋转中心32例33髋。采用自体股骨头结构性植骨重建髋臼旋转中心6例8髋。采用S-ROM高组配式假体1例1髋。平均随访时间3.5年。结果Harris评分术后平均89分,较术前改善46分。优27例,良9例,中2例,差1例,优良率达到84.6%。1例评分为差者随访3年,有疼痛与假体松动征象。本组双下肢短缩均有明显改善,未出现感染、脱位、神经损伤并发症。结论对成人DDH应用Crowe分型结合不同方法行全髋关节置换,通过结构性植骨重建髋臼旋转中心,假体行生物型固定,应用高组配式假体均为可靠而有效的方法。

Objective To evaluate the efficacy of total hip arthroplasty （THA） in patients with adult developmental dysplasia. Methods From January 1995 to June 2007 there were performed for 39 patients 42 hips of DDH 3 males 3 hips and 36 femals 39 hips with an average age of 51 years（range from 41467 years）. Based on radiographic classification of Crowe,there Were 29（30 hips）in Ⅰ Ⅱ type,9（11 hips）in Ⅱ type,1（1 hip）in Ⅲ - Ⅳ type. In addition to the Standard procedure of THA with 32 patients（33 hips）,the method of structural bone autografting for restoring normal level of rotating center of acetabular hip in 6 patients（8 hips）was carried out. The S-ROM prosthesis was procedure of THA with one patient（1 hip）. The mean follow-up was 3.5 years. Results The Harris score increased from 46 preoperatively to 89 postoperatively,excellent results was 27 cases,good was 9 cases, and fair was 2 cases and poor was 1 case. The excellent and good rate was 84%. The poor was 1 case had pain and loosening of prosthesis in the follow-up was 3 years. Patients were can efficiently of limb lengthing. No complications were found with infection and dislocation and nerve palsy. Conclusion Structural bone autografting for restoring normal level of rotating center of acetabular hip and S-ROM prosthesis was effective for patients with adult developmental dysplasia. This process can obtain favorable results for DDH of adults with THA.