髋臼中心化的全髋关节置换术治疗髋关节发育不良型骨关节炎

Treatment for hip dysplasia osteoarthritis with total hip arthroplasty by acetabular centralization

目的探讨髋臼中心化的全髋关节置换术(THA)治疗髋关节发育不良型骨关节炎的疗效。方法 62例髋关节发育不良型骨关节炎患者(68髋)行THA手术,按时间段分为两组。A组:2006年12月前的24髋按Harris常规方法处理;B组:2007年1月后的44髋采用以卵圆窝为向导的下移加深、后上挤压植骨和钉状臼嵌合的髋臼中心化手术技术处理。手术前后测量下肢短缩,进行Harris髋关节评分,用Pagnano法测量旋转中心与实际旋转中心的垂直(Y轴)和水平(X轴)距离,统计两组术中出血量和手术时间。结果 62例均获随访,时间6～24个月。下肢短缩和Harris评分:术前两组比较差异无统计学意义(P>0.05),术后B组优于A组(P<0.05)。术中出血量B组较A组多(P<0.05),手术时间两组差异无统计学意义(P>0.05)。X、Y轴上变化:术前两组比较差异无统计学意义(P>0.05),术后B组更接近真实的旋转中心,与A组比较差异有统计学意义(P<0.05)。结论髋臼中心化的THA治疗髋关节发育不良型骨关节炎能更好地纠正旋转中心、下肢短缩,改善髋关节功能,可获得满意的临床疗效。

Objective To investigate the effectiveness of treatment for hip dysplasia and osteoarthritis with total hip arthroplasty （THA） by acetabular centralization. Methods 62 patients （68 hips） of hip dysplasia with osteoarthritis had been operated with THA surgery, and were divided into 2 groups according to time period. Group A：Before December 2006, 24 hips were treated by the Harris methods ; Group B ： After January 2007, 44 hips were treated by ae- etabular centralization including downward movement and deepening of the oval fossa as a guide and the extrusion of acetabular bone graft and chimeric spike hip acetabular. Both groups before and after measurement of lower limb shortening, Harris hip score and used the Pagnano method measured the center of rotation and the actual center of rotation of the vertical （Y-axis） and horizontal （X-axis） distance, and statistics of the two sets of intraoperative blood loss and operative time. Results All patients were followed up for 6 - 24 months. Shortening of lower limb and the Harris hip score： no significant difference between the two groups in preoperative（ P 〉 0. 05 ）, the postoperative group B was superior to group A （P 〈 0. 05 ）. Intraoperative blood loss in group B were significantly more than group A, while no difference in operative time （ P 〉 0. 05 ）. The change on the X- and Y-axis ： no statistical difference between the two groups in preoperative （ P 〉 0. 05 ）, however, group B was closer to the true center of rotation after surgery, the differences were significant compared with group A （ P 〈 0. 05 ）. Conclusions The treatment of the adverse oste- oarthritis with THA by acetabular centralized can be better to correct the center of rotation and the shortening of lower limb, more improve function of hip joint, be satisfied with the clinical effect.