S-ROM假体全髋关节置换治疗CroweⅣ型髋关节发育不良

Total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip with S-ROM prosthesis

目的:探讨S-ROM假体全髋关节置换术治疗CroweⅣ型髋关节发育不良的方法并评价其疗效。方法:2000年10月至2011年10月,应用全髋关节置换术治疗CroweⅣ型髋关节发育不良患者30例36髋,其中6例双侧,24例单侧。采用S-ROM假体结合股骨转子下横断截骨短缩行人工关节置换术,髋臼侧均采用生物型假体,假体在真臼水平或接近于真臼水平植入。对临床结果采用改良Harris评分进行评价,术前及术后随访时均拍X线片进行观察。结果:30例中早期死亡l例(双髋),失访2例(2髋),余27例32髋获得随访,时间7～84个月,平均48个月。2髋分别于术后12、18个月随访时仍可见骨折线,下肢行走无异常,术后未发生感染或神经损伤等严重并发症。改良Harris评分由术前平均41.7±3.7改善至术后89.1±2.9。无假体松动或位置不当需要翻修的病例。影像学复查显示关节假体在位,金属臼杯、股骨假体与宿主骨嵌合良好,无明显松动。所有施行臼侧植骨及股骨截骨的患者植骨及截骨处均骨性愈合,无假体松动,活动度无明显受限,患髋无痛,Trendelenburg征阴性,均无须使用行走辅助工具。结论:对CroweⅣ型髋关节发育不良患者行全髋关节置换术时,良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用S-ROM组配式股骨柄假体假体能提高全髋关节置换术的治疗效果。

Objective：To develop the techniques of total hip arthroplasty （THA） for Crowe typeⅣ developmental dyspla- sia of the hip （DDH） with S-ROM prosthesis,and to assess its clinical results. Methods：From October 2000 to October 2011,30 patients （36 hips ） with Crowe type Ⅳ DDH underwent THA, including 6 patients with bilateral hip involved and 24 patients with unilateral. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy. All the cementless acetabular cups were placed at the original anatomic location. The threaded cups were put in or near the level of the true ac- etabulum in all patients. Full coating stems were used in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow-up. Results： Two patients lost of follow- up. Twenty-seven patients with 32 hips were followed up,and the average duration was 48 months （ranging from 7 to 84 months）. There was 1 patient with bilateral THA died from hemorrhagic shock. Two patients could walk freely with the visible fracture lines at 12th and 18th months postoperatively. There were no complications such as infection or nerve injuries. Modi- fied Harris Hip Score improved from preoperative 41.7±3.7 to postoperative 89.1±2.9. There was no acetabular or femoral com- ponent revision because of mal-position or loosening of the prostheses in all patients. Postoperative X-ray showed that all the prostheses in place,good integration between acetabular cups,femoral prosthesis and host bone without loosening. All bone grafts were integrated. All the hips acquired union of osteotomy and bone in-growth. None of the patients had radiographic evi- dence of aseptic loosening of prosthesis. Conclusion： For the complex DDH, follow methods should be used to improve thera- peutic effects：good exposure of the true acetabulum,deepen acetabulum,femoral shortening,oblique osteotomy,using the S- ROM prosthesis.