两种截骨术在成人Crowe Ⅳ型先天性髋关节发育不良人工全髋关节置换术中的比较研究

A COMPARATIVE STUDY ON TWO OSTEOTOMIES IN TOTAL HIP ARTHROPLASTY FOR CROWE TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP

目的比较人工全髋关节置换术（total hip arthroplasty,THA）治疗成人CroweⅣ型先天性髋关节发育不良（developmental dysplasia of the hip,DDH）时,分别采用大转子截骨或转子下截骨的疗效差异。方法 2007年6月-2013年12月,36例（43髋）CroweⅣ型DDH患者行THA,其中19例（23髋）术中采用大转子截骨（A组）,17例（20髋）采用转子下截骨（B组）。两组患者性别、年龄、身体质量指数、侧别及术前Harris评分、双下肢长度差比较,差异均无统计学意义（P〉0.05）。记录并比较两组手术时间、出血量、住院时间、术中及术后并发症发生情况、髋关节Harris评分、双下肢长度差。结果两组手术时间、出血量与住院时间比较,差异均无统计学意义（P〉0.05）。A、B组术中并发症发生率分别为21.7%（5/23）、5%（1/20）,术后并发症发生率分别为10.5%（2/19）、22.2%（4/18）,比较差异均无统计学意义（P〉0.05）。31例（37髋）获随访,其中A组16例（19髋）,B组15例（18髋）;随访时间1～7年,平均3年。X线片复查示,两组假体均在位良好。末次随访,A、B组Harris评分均较术前显著提高（P〈0.05）,两组间比较差异无统计学意义（P〉0.05）。两组患者术后双下肢长度差比较,差异无统计学意义（t=—1.343,P=0.188）。结论 THA结合大转子截骨或转子下截骨均可有效处理成人CroweⅣ型DDH高位脱位,但转子下截骨在调整肢体长度方面更具优势。

Objective To assess the effectiveness of two osteotomy methods in total hip arthroplasty（THA） for treating Crowe type IV adult developmental dysplasia of the hip（DDH）, trochanteric osteotomy and subtrochanteric osteotomy. Methods A retrospective analysis was made on the clinical data of 36 patients（43 hips） with Crowe type IV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients（23 hips） underwent trochanteric osteotomy（group A） and 17 patients（20 hips） underwent subtrochanteric osteotomy（group B）. There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups（P〉0.05）. The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups. Results There was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups（P〉0.05）. The rate of intraoperative complication was 21.7%（5/23） in group A and 5.0%（1/20） in group B, showing no significant difference between 2 groups（P0.05）. The rate of postoperative complications was 10.5%（2/19） in group A and 22.2%（4/18） in group B, showing no significant difference between 2 groups（P〉0.05）. Thirty-one patients（37 hips） were followed up 1-7 years（mean, 3 years）, including 16 cases（19 hips） in group A and 15 cases（18 hips） in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups（P〈0.05）, but there was no significant difference between 2 groups（P〉0.05）. The postoperative discrepancy of bilateral lower limbs had no significant difference（t= —1.343, P=0.188）. Conclusion THA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type IV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.