全髋关节置换术治疗髋关节发育不良的临床疗效分析

Clinical analysis of the treatment of developmental dysplasia of the hip in adults with the total hip replacement

目的分析先天性髋关节发育不良(developmental dysplasia of the hip,DDH)行全髋置换的治疗效果,探讨其手术方法和假体的选择。方法回顾分析2004年6月至2007年6月收治的65例(78髋)成人先天性髋关节发育不良患者,男19例,女46例;年龄33～64岁,平均42岁。按Crowe分型标准,Ⅰ型12例,Ⅱ型26例,Ⅲ型24例,Ⅳ型16例;术前Harris评分35～78分(平均42.7分),Ⅰ～Ⅱ型患者行常规全髋置换,Ⅲ型患者髋臼骨质缺损部植骨后行全髋置换,Ⅳ型患者股骨短缩截骨后使用特殊假体。结果65例患者均获得随访,随访时间2.5～5.5年,术后Harris评分68～94分(平均84分),除2例CroweⅣ型患者术后患肢大腿内侧出现麻木(给予功能锻炼、药物治疗后,分别于术后半年、1年后症状消失),其余患者无骨折、感染、深静脉血栓形成或假体松动、脱位等并发症,CroweⅣ患者截骨处骨愈合均良好。结论全髋关节置换术是治疗成人先天性髋关节发育不良继发骨性关节炎、脱位的有效方法,但手术难度大,应针对髋臼病变程度的不同及术前情况制定合适的方案,采用不同的关节假体,配合术中的正确操作,才能提高疗效,减少并发症。

Objective To explore the surgical management and prosthesis option to total hip replacement（THR） in the treatment of osteoarthritis and dislocation secondary to developmental dysplasia of hip in adults.Methods A retrospective analysis was done on 65 patients with osteoarthritis and dislocation secondary to developmental dysplasia of hip undergone total hip replacement from June 2004 to June 2007.Nineteen males and forty-six females were included,with 13 bilateral hip and 52 unilateral hip.According to the Crowe classification,12 typeⅠ,26 typeⅡ,24 typeⅢ,16 typeⅣ.The preoperative Harris score ranged from 35 -78（average 42.7）.The patients of typeⅠ,Ⅱundergone regular THR.The typeⅢundergone THR after bone grafting in the bone defected area of the acetabular socket.The typeⅣun- dergone THR with special prosthesis after femur crispatura osteotomy.Results The operations had been performed successfully. All 65 patients were followed up from 2.5 year to 5.5 year.The postoperative Harris score ranged from 68 to 94 （average 84）.All patients recovered well with no complications,the interceptive bone in the femur osteotomy area healed well,except for 2 typeⅣpatients got interfeminium numbness（after symptomatic treatment,the symptom disappeared in one year）.Conclusion THR is an effective way in treating osteoarthritis and dislocation secondary to developmental dysplasia of the hip,but the operation is complicated.The key point to success are the careful preoperative planning,the most suitable prosthesis,and the smart surgical technique.