组配式S-ROM假体结合粗隆下截骨治疗CroweⅣ型髋关节发育不良的疗效分析

Effct of modular S-ROM prosthesis combined with subtrochanteric osteotomy for Crowe Ⅳ developmental dysplasia of hip

[目的]探讨组配式S-ROM假体结合粗隆下截骨在治疗CroweⅣ型髋关节发育不良中的临床疗效。[方法]选取30例CroweⅣ型髋关节发育不良的患者,男11例,女19例;年龄16~28岁,平均20岁。其中单侧29例,双侧1例。采用组配式S-ROM假体结合粗隆下截骨进行治疗,术后平均随访18个月（12~26个月）,评估术后髋关节功能、股区视觉模拟评分（VAS）、肢体长度及放射学评价。[结果]30例患者全髋置换术后X线片显示假体初始固定效果优良,术后6个月Harris评分由术前的（38.6±3.7）分恢复到术后的（87.3±3.5）分,差异有统计学意义（P〈0.05）;术前、术后股区视觉模拟评分（VAS）由术前的（6.0±1.8）分改善至术后的（0.65±1.35）分;术后股区无疼痛,患肢平均延长3 cm;术后首次X线片显示股骨柄假体的初始固定良好,随访期间,术后6个月X线片显示有1例股骨柄假体下沉〈1.5 mm,此后未出现假体松动及下沉征象、骨折、脱位、感染等并发症。[结论]组配式S-ROM假体结合粗隆下截骨在治疗CroweⅣ型髋关节发育不良患者进行人工全髋关节置换术上疗效确切,能解决髋关节发育存在的解剖变异,可有效改善关节功能,提高患者生活质量。

[Objective] To investigate the clinical outcomes of the modular S- ROM prosthesis combined with subtrochanteric osteotomy for Crowe Ⅳ developmental dysplasia of hip. [Methods] A total of 30 patients with Crowe Ⅳ developmental dysplasia of hip were selected,including 11 males and 19 females,aged from 16 to 28 years with an average age of 20 years. Of them,29 cases were unilateral hip disease and 1 case was bilateral hip disease. All patients were treated with the modular S-ROM prosthesis combined with subtrochanteric osteotomy. The postoperative hip joint function was assessed by using visual analogue scale of femoral region（ VAS）,and the evaluation of limb length and radiography. [Results] All patients were followed up for an avevage of 18 months（ range,12 ~ 26 months） after surgery. The immediately postoperative X- ray images showed a good effect of initial fixation of prosthesis. At the postoperative 6th month,one subside 1. 5 mm of the femoral neck prosthesis was found,thereafter,no signs of loosening and subsidence,fracture,dislocation,infection and other complications appeared. Harris hip score improved from（ 38. 6 ± 3. 7） points preoperatively to（ 87. 3 ± 3. 5） points postoperatively,showing significant difference（ P 0. 05）. The visual analogue scale of femoral region（ VAS） improved from（ 6. 0 ± 1. 8） points preoperatively to（ 0. 65 ± 1. 35） points postoperatively,without any pain in femoral area postoperatively,showing significant difference（ P 0. 05）. Injured limbs were extended by an average of 3 cm. [Conclusion] The modular S- ROM prosthesis combined with subtrochanteric osteotomy has an exact efficacy in total hip arthroplasty for patients with Crowe Ⅳ developmental dysplasia of hip,which can solve the problem of anatomical variations in hip development,improve hip function,and enhance the quality of patients＇ life.