自体骨植骨在治疗髋关节发育不良CroweⅢ型和Ⅳ型髋臼缺损中的应用研究

Applied research on autologous bone graft for acetabular defect of Crowetype Ⅲ and Ⅳ hip dysplasia

目的 ：观察自体骨植骨在治疗髋关节发育不良CroweⅢ、Ⅳ型髋臼缺损中的效果。方法：2010年3月至2013年5月采取全髋关节置换术（total hip arthroplasty,THA）治疗22例25髋CroweⅢ、Ⅳ型成人髋关节发育不良继发骨性关节炎,25髋均进行自体骨植骨改善髋臼骨缺损,其中男3例4髋,女19例21髋;年龄43~67岁,平均55岁;CroweⅢ型6髋,Ⅳ型19髋。术前所有患者髋关节疼痛,肢体短缩,髋关节功能受限。术后12个月观察患者肢体长度恢复情况、功能恢复、自体骨植骨融合情况。结果：22例均获随访,时间1年3个月~4年,平均3年9个月。所有患者无不良反应发生,植骨均融合。术后12个月Harris评分88.30±6.13,优18例,良4例。双下肢长度差由治疗前的（3.20±0.81）cm减小到术后12个月（0.92±0.23）cm（t=14.864,P〈0.05）。结论 ：髋关节发育不良继发骨关节炎采取全髋关节置换术时,采用自体骨植骨能有效改善髋臼骨缺损,有利于恢复髋臼旋转中心,提供良好髋臼固定,明显提高手术治疗效果。

Objective：To study clinical efficacy of autologous bone graft for acetabular defect of Crowe Ⅲ and Ⅳ hip dysplasia. Methods：The 22 patients with 25 hips of DDH（Crowe type Ⅲ,Ⅳ） from March 2010 to May 2013 were retrospectively analyzed. Total hip arthroplasty（THA） combined autogenous bone grafting was performed for all these patients with osteoarthritis secondary to DDH. Among them,19 patients were females（21 hips） and 3 patients were males（4 hips）,ranging in age from 43 to 67 years old,averaged 55 years old. There were 6 hips with Crowe type Ⅲ and 19 hips with Crowe type Ⅳ. Before surgery,all the patients had hip pain,limb shortening and hip limited function of hip joint. After 12 months,the degree of recovery about limb length,functional recovery,autogenous bone graft fusion were observed. Results：All the patients were followed up and no dislocation were occurred. At 12 months after operation,the average Harris hip joint llzncation score were83.30 ±6.13,and 18 cases got an excellent result and 4 good. The length of lower limbs decreased from preoperative（3.20 ±0.81） cm to 12 months after operation（0.92±0.23） cm（t=14.864,P〈0.05）. Conclusion：THA combined with structural femoral head autograft for patients with osteoarthritis secondary to DDH can obtain favorable results,significantly improving the effect of operation treatment.