全髋关节置换术治疗成人发育性髋关节发育不良的中期研究

Mid-term Research on Total Hip Replacement for Developmental Dysplasia of Hip in Adults

目的探讨人工全髋关节置换术（total hip replacement,THR）在成人发育性髋关节发育不良（developmental dysplasia of the hip,DDH）继发骨性关节炎的中期治疗经验。方法对26例（29髋）DDH继发骨性关节炎的患者行THR。对23例中、重度骨缺损者,采用植骨修补外上方承重区骨缺损,并重建髋臼及股骨的解剖结构,合理安装假体。结果随访9个月~6年,Harris关节功能评分由术前的平均（33.8±0.7）分提高到术后的（87.1±0.3）分。所有患者活动度增加,未出现骨折不愈合、内固定断裂、感染、神经损伤、下肢深静脉血栓形成及假体周围骨折等并发症。8例双下肢不等长者,短缩差由术前平均2.7（2.1-4.5）cm缩小到术后平均0.5（0.1-0.7）cm,外观改善明显。结论 DDH继发骨性关节炎采用THR是行之有效的。充分的软组织松解、重建髋臼和股骨近端结构以及合适的假体选择是手术的关键。

Objective To explore the experience of the total hip replacement（THR） in treatment of developmental dysplasia of the hip（DDH） with secondary osteoarthritis in adults.Methods 26 adults（29 hips） suffered from DDH with secondary osteoarthritis were treated by THR.23 cases with moderate and severe bone defect were performed autograft taken from femoral neck inferior compact bone to restore bone defect of superolateral area,restitute the anatomic structure of the acetabulum and femur and assemble the prosthesis properly.Results All cases were followed up for 9 months to 6 years.The average Harris score of joint function was increased from 33.8±0.7 preoperatively to 87.1±0.3 postoperatively.In the 8 cases with limb shortening,the discrepancy of lower extremities was reduced from mean 2.7 cm（ranged 2.1 to 4.5 cm） preoperatively to 0.5 cm（ranged 0.1 to 0.7） postoperatively,and the appearance was improved obviously.All patients revealed joint range of motion improved without complications such as fracture nonunion,internal fixator breaking,infection,nerve injury,deep venous thrombosis of lower limbs and prosthesis adjacent fracture.Conclusions THR is an effective method for treatment of DDH with secondary osteoarthritis.Abundant soft tissue release,reconstruction of the acetabulum and proximal femur and proper prosthesis selection are the key points of THR.