全髋关节表面置换术治疗成人髋关节发育不良25例中期随访

Midterm Results of Total Hip Resurfacing Arthroplasty for Treatment of Developmental Dysplasia of the Hip

目的探讨全髋关节表面置换术(total hip resurfacing arthroplasty,THRA)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)继发骨关节炎的中期疗效。方法2005年3月至2006年6月,采用THRA治疗DDH患者25例,女18例,男7例;30～59岁,平均48岁;双髋1例,共26髋。根据Hartofilakidis分型,半脱位22髋,低位脱位4髋。采用Conserve-plus金属对金属全髋关节表面置换假体,髋臼假体为非骨水泥固定,股骨头假体采用低黏骨水泥固定。临床随访采用Harris评分,测量髋臼外展角、垂直距离、水平距离、股骨柄干角、髋臼假体覆盖率;记录髋臼和股骨假体周围透亮线及骨溶解;以各种原因所致翻修或影像学松动为随访终点。结果所有患者均随访3年以上,平均随访3.5年。截至随访终点无翻修或影像学松动。患者的Harris评分由术前平均46分提高至术后平均92.1分,26髋均为优。术后轻度跛行2例,所有患者均无迟发感染、术后股骨颈骨折、术后残余股骨头坏死、术后假体松动、脱位、术后异位骨化。髋关节活动度:屈曲由97.5°增加至127.5°,外展由19.3°增加至40°,外旋由23.2°增加至42.5°,内旋由4.2°增加至28.5°。X线片显示:关节假体位置正常,髋臼假体平均外展角为41.6°,髋关节旋转中心位置平均下移6.2 mm、内移15 mm,股骨柄干角平均146.4°。宿主骨对臼杯的平均覆盖率为94.4%,1例宿主骨与臼杯界面在2区出现透亮线,宿主骨与股骨假体柄界面无一例出现透亮线。结论THRA治疗成人半脱位型及低位脱位型DDH继发骨关节炎具有良好的中期疗效,熟练的手术技术和正确的适应证选择是降低中远期并发症的关键。

Objective To investigate the midterm results of total hip resurfacing arthroplasty （THRA） for treatment of osteoarthritis secondary to the developmental dysplasia of the hip （ DDH ）. Methods Between March 2005 and June 2006, 26 THRA were performed in 25 patients to treat advanced osteoarthritis secondary to DDH. There were 28 females and 7 males, average for 48 years old. According to the Hartofilakidis classification, 22 hips were classified as type 1 （dysplasia） ; 4 hips were classified as type 2 （low dislocation）. Clinical outcomes were evaluated according to Harris score. Abduction angle, vertical and transverse distance of acetabulum, stem - shaft angle and cover rate of cup were measured radiologieally. The radiolucent line and osteolysis around the prosthesis were also recorded. Results The mean follow - up time of the 25 patients （26 hips） who completed the follow - up was 3.5 years. Using loosening or revision as the end point for failure, the survival rate was 100%. The mean preoperative Harris hip score was 46 points, which im- proved to 92. 1 points at the final follow - up. All the patients get satisfactory results, no late complication happen. For the range of motion： the flexion improved from 97.5°to 127. 5° , abduction improved from 19. 3° to 40°, external rotation im- proved from 23.2° to 42.5°, internal rotation improved from 4. 2° to 28. 5°. Radiologieal exam showed that the position of cup restored more anatomically after operation and there was only one case presented radiolueent line at acetabular side in zone 2. Conclusions The midterm results of THRA for treatment of osteoarthritis secondary to DDH is encouraging. Skillful surgical techniques and appropriate indications are the keypoints to avoid the late complications.