髋臼内移技术在全髋关节置换术治疗髋关节发育不良中的应用

Application of medial protrusion technique in total hip arthroplasty for developmental dysplasia hips

目的探讨髋臼内移技术在全髋关节置换术(THA)治疗髋关节发育不良(DDH)中的应用效果。方法分析31例(38髋)接受THA的CroweⅡ～Ⅳ型DDH患者(术中均应用髋臼内移技术)的临床资料。观察术后早期并发症;通过影像学检查和Harris评分评价术后功能。结果术中发现髋臼骨折3例;术后发生早期脱位1例(术后3个月)、臼缘-股骨颈撞击综合征3例、臼杯移位1例。术中获得平均髋臼内移距离为12 mm(5～20 mm),平均臼杯覆盖率为85%(70%～100%)。平均髋臼外展角为47.5°(42°～65°),其中4例臼杯外翻位置入(外展角>60°)。术前平均Harris评分为46.6(38～77),术后为83.0(65～92),差异有统计学意义(P<0.05)。结论髋臼内移技术是一种有效的DDH髋臼重建技术,但需要准确的术前计划及良好的术中操作,以避免早期并发症的发生。

Objective To investigate the application of medial protrusion technique in total hip arthroplasty （THA） for developmental dysplasia hips （ DDH）. Methods The clinical data of 31 patients （38 hips） with DDH of Crowe type Ⅱ - IV undergoing THA were retrospectively analysed, and all patients were treated with medial protrusion technique in THA. The incidence of complications early after operation was observed, and Harris scores and radiologieal measurements were used for function evaluation after operation. Results Three cases of aeetabular fractures were identified during operation. One case of posterior dislocation （3 months after operation）, three cases of impingement syndrome and one case of cup displacement were found after operation. The mean distance of medial placement was 12 mm （5 to 20 mm）, with a mean acetabular coverage of 85% （70% to 100%）. The average inclination angle was 47.5° （42° to 65°）, and valgus placement of acetabular components was found in 4 cases with inclination angle over 60°. The mean Harris score was 46.6 （38-77） before operation and 83.0 （65 -92） after operation, and there were significant differences between them （P 〈 0.05）. Conclusion The medial protrusion technique is effective in reconstruction of the hip rotator center in THA for DDH. However, precise preoperative planning and controllable operative techniques are required to decrease the incidence of complications early after operation.