大转子截骨非骨水泥全髋置换治疗成人髋关节发育不良

Cementless total hip arthroplasty for the treatment of developmental dysplasia of adult hip

背景:人工全髋关节置换是公认的治疗成人髋关节发育不良晚期髋关节病变的有效手段,但存在较多的困难及风险。目的:评估行大转子截骨的非骨水泥全髋置换治疗CroweⅣ型成人髋关节发育不良的短期疗效。方法:18例(22髋)成人CroweⅣ型发育性髋关节脱位患者采用后外侧入路非骨水泥固定,行大转子截骨调整臀中肌张力,在髋臼的解剖位置安放臼杯。结果与结论:患者随访均超过10个月,最长随访38个月。患者关节置换前平均患肢短缩4.5cm(3.4-6.0cm),置换后患肢较置换前平均延长4.0cm(3.2-4.8cm)。置换后最终随访时Harris评分平均87分(79分-91分),显著高于置换前(P<0.01)。置换中3例3髋股骨近端发生骨折,但股骨假体稳定,予钢丝固定或未作特殊处理,均于置换后2个月复查X射线片提示骨折已愈合。1例置换后出现坐骨神经麻痹症状,3个月后症状消失。未出现置换后髋关节脱位、假体松动、感染及有临床表现的深静脉血栓形成等并发症。表明行大转子截骨的非水泥假体能有效治疗CroweⅣ型成人发育性髋关节脱位,能重建复杂髋关节发育不良的生物学及生物力学,不增加并发症风险。

BACKGROUND： Total hip arthroplasty is considered as an effective method for the treatment of hip dysplasia with advanced hip disease, but there exists many difficulties and risks. OBJECTIVE： To evaluate the short-term outcome of cementless total hip arthroplasy for the treatment of Crowe- 1V developmental dysplasia of the hip. METHODS： Eighteen adult patients （22 hips） with Crowe-IVdevelopmental dysplasia of the hip underwent primary tota hip arthroplasty. All cases were accomplished through posterolateral approach bone cement fixation, and the greater trochanter osteotomy was performed to adjust the gluteal muscle tension. The acetabular cups were established at the level of the true acetabulum as near as possible. RESULTS AND CONCLUSION： All the patients were followed-up for more than 10 months, and the longest follow-up time was 38 months. The mean lower limb length was 4.5 cm （3.4-6.0 cm） before surgery, and it was 4.0 cm longer than that before surgery （range 3.2-4.8 cm）. The mean Harris hip score at the final follow-up after surgery was 87 （range 79-91 ） and was significantly increased than that before surgery （P 〈 0.01 ）. During the replacement, 3 cases （3 hips） suffered from fracture with femoral prosthesis stability. And these three cases were treated with wire fixation or without any special treatment, and the X-ray film at 2 months after treatment showed that the fractures were healed. One case had the symptoms of sciatic nerve palsy after replacement and 3 months later, the symptoms disappeared. There was no loosening, dislocation, infection or deep venous thrombosis in any patient. Cementless total hip arthroplasty with osteotomy of the greater trochanter for Crowe -IV developmental dysplasia of the hip was an effective procedure to establish the biomechanics and improve the function of the hip.