股骨转子下截骨的全髋关节置换治疗高脱位髋臼发育不良

Crowe Ⅳ developmental dysplasia treated by total hip arthroplasty with subtrochanteric osteotomy

背景:高位脱位的髋臼发育不良患者的骨性和软组织畸形严重,常规的全髋关节置换风险高,并发症多,而结合股骨转子下截骨的全髋关节置换可以简化置换方法。目的:回顾性分析人工全髋关节置换结合股骨转子下截骨治疗高位脱位髋臼发育不良患者17例的疗效及安全性。方法:对2006年1月到2011年6月在北京积水潭医院行人工全髋关节置换结合股骨转子下截骨治疗髋臼发育不良的患者17例的临床资料进行回顾性分析,均获得至少2年以上随访,共21髋关节,对置换并发症、髋关节功能改善以及髋关节部位影像学改变进行评估。结果与结论:患者平均随访(48.0±20.5)个月。患者置换后Harris评分高于置换前(P<0.05)。患者主要症状为双下肢不等长,下蹲后站起困难、下肢力量不足及下肢软组织紧张。1髋发生大转子骨折以钢爪固定;4髋在置换中股骨距裂纹骨折以钢丝捆绑。1例患者置换后出现股神经损伤表现,获得部分恢复。所有患者无感染、脱位和假体松动出现。结果说明,结合股骨转子下截骨短缩的人工全髋关节置换是治疗髋关节脱位的有效方法,安全可靠,但仍需要一定的置换技术控制其并发症的发生,其长期结果有待进一步随访。

BACKGROUND： Crowe IV developmental dysplasia of the hip is rarely seen clinically. However, when treated with routine total hip arthroplasty, severe deformities in the bone and soft tissue can lead to high rate of operation failure and increased occurrence of complications. Total hip arthroplasty in combination with subtrochanteric osteotomy may be an option to resolve this problem. OBJECTIVE： To retrospectively analyze the clinical outcome and safety of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy in 17 cases. METHODS： Twenty-one hips（17 cases） of Crowe IV developmental dysplasia of the hip treated by the combination of total hip arthroplasty and subtrochanteric osteotomy were retrospectively analyzed and followed for at least 2 years from January 2006 to June 2011. Complications, hip function, and radiological changes were evaluated. RESULTS AND CONCLUSION： The mean follow-up period was（48.0±20.5） months. Harris＇ s score was increased postoperatively（P 0.05）. The main complains were lower limb length discrepancy, difficulty in standing up from squatting, muscle weakness, and soft tissue tightness. One greater trochanter fracture occurred and was fixed by hook plate fixation. There were four femoral shaft splits treated by cerclage. One patient represented with femoral nerve palsy and got partial recovery until the latest follow-up. There was no deep infection, dislocation or prosthesis loosening. Crowe IV developmental dysplasia of the hip could be effectively treated by total hip arthroplasty in combination with subtrochanteric osteotomy, which requires high surgical techniques to control the complications. Further follow-up is required for long-term results.