人工全髋关节置换治疗发育性髋发育不良继发晚期骨关节炎

Total hip replacement for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip

目的:探讨人工全髋关节置换治疗发育性髋发育不良(developmental dysplasia of hip,DDH)继发晚期骨关节炎的手术要点和临床疗效。方法:2004年5月至2008年3月,我科对32例36髋DDH继发晚期骨关节炎患者施行人工全髋关节置换术。髋臼均在真臼处重建,骨水泥固定16髋,非骨水泥固定20髋。术后平均随访31.3个月。采用Harris髋关节功能评分及X线检查评价临床效果。结果:术后肢体延长(3.4±1.3)cm。并发股骨骨折2例,坐骨神经牵拉症状1例;未出现感染、脱位、有症状的深静脉血栓形成。分别将术后第3天、第14天和最终随访时间的Harris评分与术前评分进行比较,差异有统计学意义(均P<0.05)。随访期内X线照片未见异位骨化、假体松动、下沉等现象,无翻修病例。结论:人工全髋关节置换术是治疗发育性髋发育不良继发晚期骨关节炎的有效方法。在真臼处重建髋臼和选择恰当假体置入是取得良好疗效的关键。

Objective To investigate the surgical techniques and clinical outcomes of total hip replacement for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. Methods From May 2004 to March 2008, a total of 36 total hip replacements were performed in 32 patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The aeetab- ulum cup was reconstructed in the corresponding anatomical position in all cases. Cemented components were used in 16 hips, and cementless components in the other 20 hips. The mean follow-up was 31.3 months. Clinical outcomes were determined with Harris hip score. Radiographs were taken after the surgery and in every follow-up examination for further reference. Results All patients post- operatively gained a limb lengthening with an average of （ 3.4 ± 1.3 ） cm. Three patients had complications, 2 had nondisplaced fractures of the proximal part of the femur, and 1 sciatic nerve palsy which disappeared after 3 months. There was no infection, dislocation and symptomatic deep veinthrombosis. Compared with preoperation, the mean Harris hip scores on the 3 rd day, the 14th day after the operation and at the last follow-up were all improved significantly （ all P 〈 0. 05 ）. There was no loosening, migration, heterotopic ossification radiographically, and no revision during the follow-up. Conclusion Total hip replacement is an effective treatment for patients with end-stage osteoarthritis secondary to developmental dysplasia of the hip. The key is to place the aeetabulum cup in the corresponding anatomical position, and choose proper prosthesises during the surgery