生物型人工全髋关节置换术治疗Crowe Ⅲ型成人髋关节发育不良的疗效观察

CEMENTLESS TOTAL HIP ARTHROPLASTY FOR TREATMENT OF Crowe TYPE Ⅲ DEVELOPMENTAL DYSPLASIA OF HIP IN ADULTS

目的探讨生物型人工全髋关节置换术（total hip arthroplasty,THA）治疗CroweⅢ型成人髋关节发育不良（developmental dysplasia of hip,DDH）的疗效。方法2013年9月-2015年9月,收治50例（51髋）CroweⅢ型DDH患者。男20例（20髋）,女30例（31髋）;年龄19~55岁,平均39岁。左髋34例、右髋15例,双髋1例。患者均伴明显跛行步态,患侧髋关节疼痛明显。临床症状出现至入院就诊时间为10~47个月,平均26个月。患髋＂4＂字征、Trendenleburg征均呈阳性,髋关节Harris评分为（38.9±7.1）分。单髋患者双下肢长度相差2.5~4.0 cm,平均3.3 cm。患者均采用生物型假体行THA,其中28例（28髋）行自体股骨头结构性植骨。结果术后患者切口均Ⅰ期愈合。2例（2髋）出现股神经牵拉麻木疼痛,7例（7髋）出现患肢肿胀,均对症处理后症状消失。50例均获随访,随访时间6~18个月,平均10个月。患者跛行步态均明显改善;4例（5髋）髋关节疼痛较术前明显缓解,46例（46髋）髋关节无疼痛。X线片复查示,髋关节外上方结构性植骨均在术后3~6个月达骨性愈合,平均5个月;随访期间假体均无松动、下沉;末次随访时单髋患者双下肢长度相差0~1 cm,平均0.4 cm,视为双下肢等长。末次随访,髋关节Harris评分为（91.2±2.8）分,与术前比较差异有统计学意义（t=—79.77,P=0.00）。结论对于CroweⅢ型成人DDH患者,采用生物型THA治疗可获得较好疗效。

Objective To investigate the value of cementless total hip arthroplasty（THA） for the treatment of Crowe type III developmental dysplasia of hip（DDH） in adults. Methods Between September 2013 and September 2015, 50 patients（ 51 hips） with Crowe type III DDH were treated. There were 20 males（ 20 hips） and 30 females（ 31 hips）, with the average age of 39 years（range, 19- 55 years）. The left side was involved in 34 cases, the right side in 15 cases, and both sides in 1 case. All patients had the symptoms of limp walking and hip pain. The disease duration was 10-47 months（mean, 26 months）. The sign of ＂ 4 ＂ number test and Trendenleburg sign were positive; the Harris score was 38. 9 ± 7. 1. The bilateral lower extremities discrepancy was 2. 5- 4. 0 cm（mean, 3. 3 cm） before operation. All the patients underwent cementless THA, and acetabulum by structural femoral head autograft was performed in 28 cases（ 28 hips）. Results After operation, the incision healed by first intention. Only 2 patients（ 2 hips） had femoral nerve palsy, and 7 patients（ 7 hips） had leg swelling, which were cured after symptomatic treatment. All the patients were followed up 6- 18 months（mean, 10 months）. The sign of limp walking was improved after operation, hip pain was relieved in 46 patients（ 46 hips） and only 4 patients（ 5 hips） still had mild pain. The X-ray films showed bony healing at 3- 6 months（mean, 5 months） after operation. At last follow-up, the patients had equal limb length with the discrepancy less than 1 cm（mean, 0. 4 cm）. At last follow-up, the Harris score was significantly increased to 91. 2 ± 2. 8（t= — 79. 77, P= 0. 00）. Conclusion The cementless THA is an effective method to treat Crowe type III DDH in adults.