非骨水泥型髋关节置换术治疗成人髋臼发育不良

Cementless Total Hip Replacement for Osteoarthritis Due to Developmental Dysplasia of the Hip

目的探讨非骨水泥型髋关节置换术治疗髋臼发育不良的早期效果。方法回顾性分析2009—2013年我科非骨水泥全髋关节置换术治疗因髋臼发育不良导致的髋骨关节炎患者66例72髋,其中男9例11髋,女57例61髋;年龄46-75岁,平均55岁。按Crowe分型,Ⅰ型27例29髋,Ⅱ型17例18髋,Ⅲ型13例14髋,Ⅳ型9例11髋,均伴有不同程度的跛行、活动受限等症状。采用Harris评分及术前、术后X线片观察评价手术效果。结果术后患者肢体平均延长36 mm。66例患者均获得1-5年随访。除1例不遵守医嘱过度下蹲出现脱位后在全麻下闭合手法复位,所有患者髋臼重建侧植骨均获得愈合,髋关节假体均未出现假体松动。2例自体股骨头植骨区有少量骨吸收,未发现下肢因肢体延长致神经血管损伤症状。术前患者Harris评分（45.05±5.38）分、术前下肢不等长（23.29±19.36）mm、CE角（4±13.92）°改善至（88.62±3.38）°、（3.26±4.06）mm、（29.27±2.68）°,差异均有统计学意义（P〈0.05）。术后髋关节旋转中心距泪滴水平距离为（27.82±1.25）mm,垂直距离（24.14±2.59）mm。结论全髋关节置换治疗髋臼发育不良手术难度大,术前精心手术评估,真臼处髋臼重建及通过适度软组织松解、转子下截骨等方式的非骨水泥型髋关节置换术治疗成人髋关节发育不良可取得显著的早期疗效。

Objective To discuss and explore the safety and efficacy of cementless total hip replacement for osteoarthritis due to developmental dysplasia of the hip.Methods We retrospectively investigated the clinical data of 66 patients（72 hips）who had received cementless total hip arthroplasty from May 2009 to May 2013.In this paper,72 total hip replacements were studied clinically and radiologically before and after surgery,with a mean follow-up of 4.2 years,using Crowe＇s classification and Harris Hip Score.Results The average Harris Hip Score improved from 45.05 to 88.62（t =-58.22,P 0.05）.Mean leg lengthening was 20.03 mm,with a leg length discrepancy which passed from a mean of 23.29 mm to a mean of 3.26 mm（t =8.22,P 0.05）.The mean of CE angle improved from 4°to 29.27°（t =-14.47,P 0.05） and no neurovascular injuries.Only one case of postoperative hip dislocation happened and by closed manipulative reduction under general anesthesia.All grafts incorporated and no additional radiographic loosenings were found.Bone resorption was found in 2 hips around the screws not adjacent to the acetabular component and were nonprogressive.Postoperative the mean of horizontal distance between the teardrop and the hip center was（27.82 ± 1.25） mm and the average vertical distance was（24.14 ± 2.59） mm.Conclusion Total hip replacement（THR） in developmental dysplasia of the hip（DDH） presents some difficulties which require an accurate preoperative evaluation,unusual technical procedures such as positioning of the acetabular component in the true acetabulum,acetabular reconstruction,the subtrochanteric shortening osteotomy and appropriate soft tissue releasing for standard THR,and sometimes,particular prosthetic models.The techniques and principles described in this paper are required to good results in this surgery.