全髋关节置换治疗CroweⅣ型成人髋关节发育性不良

Total hip arthroplasty for Crowe type IV developmental dysplasia of hip in adults

背景:人工全髋关节置换为治疗髋关节发育性不良晚期患者的最佳选择,然而髋关节发育性不良的患者特别是CroweⅣ型因其髋关节解剖结构的显著异常,增加了手术难度且手术方法颇有争议。目的:探讨人工全髋关节置换治疗CroweⅣ型成人髋关节发育性不良的疗效及髋臼重建与股骨侧处理的方法。方法:纳入12例(14髋)CroweⅣ型成人髋关节发育不良患者进行人工全髋关节置换,Harris评分术前平均(35.0±6.8)分,髋臼侧采用小臼杯结合髋臼加深技术安置臼杯假体,股骨侧行转子下短缩截骨放置股骨假体,采用Harris评分评价置换后髋关节功能。结果与结论:所有患者随访1-7年,平均4.6年,2例2髋发生置换过程中股骨大转子不全骨折,予钢丝固定。1例置换后出现坐骨神经刺激症状,1个月后恢复正常,无感染、假体松动及有明显临床表现的深静脉血栓形成等并发症。股骨侧截骨处均骨性愈合。置换后末次随访Harris评分平均为(84.0±7.0)分,置换后肢体延长4-6 cm,平均5 cm,短缩的肢体得到满意纠正。说明采用小臼杯、髋臼内陷技术、股骨短缩截骨对CroweⅣ型成人髋关节发育性不良患者行全髋关节置换能重建关节功能,恢复下肢长度,长期疗效有待于进一步观察。

BACKGROUND： Total hip arthroplasty is an optimal choice for patients with late hip dysplasia. Crowe type IV developmental dysplasia of the hip increases the difficulty of the operation, and the surgery is controversial. OBJECTIVE： To evaluate the clinical effects of total hip arthroplasty on Crowe type IV developmental dysplasia of the hip and the method of reconstruction of acetabulum and the treatment of proximal femur. METHODS： A total of 12 patients （14 hips） with Crowe type IV developmental dysplasia of the hip underwent total hip arthroplasty. Preoperative Harris hip score was averagely （35.0±6.8） points. All hips were treated with small acetabular components combined with medial protrusion technique in acetabular reconstruction, as well as subtrochanteric shortening osteotomy in femur. Joint function of hips was evaluated according to the Harris hip score. RESULTS AND CONCLUSION： All patients were followed up with an average of 4.6 years （ranged 1 to 7 years）. Two cases （two hips） suffered from infraction of greater trochanter of femur during replacement, and it was fixed with wire. There was complete sciatic nerve injury in one case, which partially restored after conservative treatment for 1 month. No infection, prosthesis loosening, or deep venous thrombosis with obvious clinical manifestations was visible. Bone union was observed at the site undergoing osteotomy at the side of femur. After replacement, final follow-up showed that Harris hip score was averagely （84.0±7.0） points. The mean amount of postoperative leg lengthening was 5 cm （range 4-6 cm）. Shortened limbs were corrected satisfactorily. These results suggested that total hip arthroplasty using small acetabular component, medial protrusion, and femoral subtrochanteric shortening osteotomy technique for the Crowe type IV developmental dysplasia of the hip can effectively restore hip function and leg length. The long-term curative effects require further investigations.