生物型小臼杯在成人Crowe Ⅳ型髋关节发育不良的应用与疗效

APPLICATION AND EFFECTIVENESS OF BIOLOGICAL TYPE ACETABULAR CUP IN ADULT Crowe TYPE IV DEVELOPMENTAL DYSPLASIA OF THE HIP

目的探讨生物型小臼杯（直径〈44 mm）在成人CroweⅣ型髋关节发育不良（developmental dysplasia of the hip,DDH）中的应用与疗效。方法 2001年4月-2013年8月,采用生物型小臼杯行全髋关节置换术治疗CroweⅣ型DDH 16例（20髋）。其中男3例,女13例;年龄31~69岁,平均49岁。患者均表现为髋关节疼痛伴下肢不等长,患肢缩短1.8~6.0 cm,平均3.5 cm。术前常规行骨盆前后位X线片明确髋臼畸形程度、头臼对合关系及脱位严重程度。术前Harris评分为（34.0±6.9）分。结果术后患者切口均Ⅰ期愈合,无感染或神经、血管损伤等并发症发生。16例均获随访,随访时间4~12年,平均7.5年。术后2周内发生脱位2例,经复位髋＂人＂字石膏固定3周后未再脱位。术后X线片示臼杯均位于真臼区,髋臼对臼杯负重区的覆盖达98.2%~99.1%,平均98.5%;臼杯从Ranawat三角内移4.6~7.0 mm、平均5.8 mm,上移4.5~7.9 mm、平均6.2 mm;位于髂耻线和Kohler线内侧的臼杯外侧表面区域均〈40%;臼杯外展角为（45±5）°,前倾角（10±5）°。随访期间除1例于术后12年因髋臼广泛骨溶解伴臼杯假体松动行髋臼侧假体翻修术外,其余患者均未见假体松动。术后1年髋关节Harris评分为（85.0±7.5）分,较术前显著改善（t=14.34,P=0.01）。结论采用髋臼磨削过程保留足够骨量结合生物型小臼杯假体置换治疗成人CroweⅣ型DDH,臼杯的覆盖率及初始固定均满意,术后早、中期疗效满意。

Objective To investigate the application and effectiveness of the biological type acetabular cup（diameter 44 mm） in adult Crowe type IV developmental dysplasia of the hip（DDH）. Methods Between April 2001 and August 2013, biological type acetabular cup was used in total hip arthroplasty for the treatment of Crowe type IV DDH in 16 cases（20 hips）. There were 3 males and 13 females, aged 31-69 years（mean, 49 years）. Unilateral hip was involved in 12 cases, and bilateral hips in 4 cases. The patients showed pain of the hip joint and inequality of lower limb（shortening of affected limb 1.8-6.0 cm in length, 3.5 cm on average）. Acetabular deformity, the relationship and the severity of femoral head dislocation were comfirmed on the X-ray films. The preoperative Harris score was 34.0±6.9. Results All patients achieved healing of incision by first intention, with no complication of infection or neurovascular injury. Sixteen cases were followed up 4-12 years（mean, 7.5 years）. At 2 weeks after operation, dislocation occurred in 2 cases, and were fixed with plaster for 3 weeks after reduction of the hip. Postoperative X-ray films showed complete reduction of femoral head; the average acetabular coverage of the cup of the weight-bearing area was 98.5%（range, 98.2%-99.1%）. The cup from the Ranawat triangle was 4.6-7.0 mm（mean, 5.8 mm） in medial shifting, and was 4.5-7.9 mm（mean, 6.2 mm） in elevation, it located at cup lateral surface area inside the iliopectineal line and the Kohler line（40%）; the cup abduction angle was（45±5）°, and the anteversion angle was（10±5）°. The other patients had no prosthesis loosening except 1 patient having extensive acetabular prosthesis loosening because of acetabular osteolysis at 12 years after operation. The hip Harris score was significantly improved to 85.0±7.5 at 1 year after operation（t=14.34, P=0.01）. Conclusion The acetabular grinding process to retain enough bone combined with a small cup of biological prosthesis treating adult Crowe type IV DDH has the advantages of satisfactory coverage and initial acetabular fixation, so good early and mid-term effectiveness can be obtained.