髋关节发育不良的严重程度与骨水泥型全髋关节置换术后髋臼假体松动的相关性

Correlation between the acetabular component loosing rate of bone-cement total hip replacement and the severity of the development dysplasia of the hip

目的探讨在骨水泥型全髋关节置换术髋臼假体的术后生存率和髋关节发育不良(development dysplasia of the hip,DDH)严重程度的相关性。方法应用骨水泥型全髋关节置换术治疗DDH合并创伤性髋关节炎患者92例103髋,女85例96髋,男7例7髋;年龄39～78岁,平均47.2岁。根据Crowe分级:42例46髋为Ⅰ度,21例24髋为Ⅱ度,16例18髋为Ⅲ度,13例15髋为Ⅳ度。49例56髋采用改良Gibson入路,43例47髋经直接外侧Hardinge入路。46例48髋使用自体股骨头进行髋臼骨移植,所有移植的骨块均用松质骨螺钉或Kirschner钢丝固定于髋臼上。进行骨移植的适应证主要是髋臼组成部分的上方未取得足够骨覆盖。结果62例76髋获得随访,随访时间2～19年,平均98个月。将因无菌性松脱而行髋臼翻修作为观察终点,10年随访髋臼假体生存率为86.8%～94.4%,平均90.6%;18年随访生存率为53.9%～72.0%,平均63.0%。结论随着髋臼发育不良严重程度的加重,随访10年后骨水泥型髋臼假体有更高的失败率。

Objective To approach the correlation between the acetabular component survival rate of bone-cement total hip replacement and the severity of the development dysplasia of the hip （DDH）. Methods Totally 92 patients from 39 to 77 years old （47. 2 years in average）, with 103 DDH complicating with secondary osteoarthritis were treated with bone-cement total hip replacement. There are 85 female patients with 96 hips and 7 male with 7 hips. According to the classification of Crowe, 42 ca- ses （46 hips） were in classI, 21 cases （24 hips） in classll, 16 cases （18 hips） in classlll and 13 cases （15 hips） in class IV. Of all, 49 cases （56 hips） were operated by the Gibson approach, 43cases （47 hips） by the Hardinge approach; and bone grafting of the acetabulum, using the patient＇s own femoral head, was performed on 46 cases （48 hips）. All the grafted bones are placed on the acetabulum by spongy bone screws or Kirschner steel-wire. The inadequate bone cover in the superior of acetabular component is the main indication of bone-grafting. Results Follow-up lasted 2 - 19 years （98 months in average） in 62 cases （76 hips）. Regarding the overhauling of the aeetabular component account of sterility loosing as the terminal point of observation, acetabular component survival rate after 10-year follow-up was 86. 8% - 94. 4%, with 90. 6% in average ; and after 18 years＇ follow-up, it was 53. 9% -72. 0%, 63. 0% in average. Conclusion After 10 years＇ follow-up, there is a higher failure rate of the bone-cement acetabular component with the aggravation of the DDH.