下肢重建方式对Crowe Ⅳ型髋关节发育不良全髋关节置换术后疗效的影响

Influence to the curative effect of THA with different methods to reconstruct limb length for CroweIV type developmental dysplasia of the hip

目的探讨不同重建方式恢复单侧Crowe1V型髋关节发育不良（developmentaldysplasiaofthehip，DDH）的患肢长度后关节功能与患者满意度的差异。方法将21例拟行全髋关节置换术的单侧Crowe1V型DDH患者随机分为代偿长度组11例（转子下截骨后按照代偿法测得的双下肢长度差重建患肢长度）和绝对长度组10例（按照双下肢绝对长度差重建患肢长度）。平均随访10年，比较两组患者Harris髋关节评分和健康调查简表SF一36（theMOSitemshortformhealthsurvey，SF一36）评分；以翻修作为终点，采用Kaplan—Meier生存分析法评估假体生存率；根据症状及X线表现评价关节功能和假体松动情况。结果17例获得随访，随访时间8～10年。两组患者Harris髋关节评分、主要的SF一36评分和假体生存率的差异无统计学意义，代偿长度组患者SF一36评分的“心理健康”项优于绝对长度组。10例出现聚乙烯磨损，6例出现大转子区严重骨质疏松，3例骨溶解。5例翻修：1例感染、1例假体周围骨折、3例无菌性松动。结论两种不同重建方式的全髋关节置换术后髋关节功能和假体生存率无差异。绝对长度组患者手术满意度低于代偿长度组，术后持续感觉双下肢不等长。

Objective To explore the differences of the joint function and the patient＇s satisfaction between two different methods to reconstruct limb length for unilateral Crowe IV developmental dysplasia of the hip （DDH）. Methods The clinical controlled study were used. 21 cases with unilateral DDH Crowe IV treated with total hip arthroplasty were divided into 2 groups randomly. The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length. The patients were followed up I0 years. Two independent sample t-test was used to compare these two operations. Harris scores and SF-36 scores were used in the test. Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test. X-ray films of different period were compared to confirm the prosthetic loosening. Results Seventeen patients were followed up 8- 10 years. There were no significant differences both in Harris score and most of the SF-36 scores at the me- dian follow-up of 10 years. The item mental healthy of SF-36 expressed significant difference. Five patients required revision. There were 10 cases suffered with polyethylene wear, 6 cases with severe osteoporosis in greater troehanter, and 3 cases with osteolytic reaction. Conclusion There are no significant differences be- tween the two surgical method in the survival rate of prosthesis and the joint function in the median follow up. The satisfaction of the control groups is lower than the trial groups both at the early stage after the oper- ation and the median follow up. The revision rate between the two groups is similar but the reason is differ- ent.