短缩截骨下S-ROM假体联合真臼位关节成形在重度髋关节发育不良中的疗效评估

Total hip arthroplasty with S-ROM prosthesis and anatomic acetabular reconstruction under subtrochanteric osteotomy for Crowe Ⅳ developmental dysplasia of hip

背景:CroweⅣ型髋臼发育不良(DDH)存在严重解剖结构异常,全髋关节置换治疗中手术难度大,并发症发生率高。目的:探讨解剖位髋臼重建、S-ROM股骨假体联合转子下截骨对重度髋关节发育不良(DDH)的治疗效果。方法:2011年2月至2015年10月,采用S-ROM假体联合转子下截骨、真臼水平重建全髋关节置换术治疗15例(17髋)CroweⅣ型DDH。比较患者手术前后Harris评分、骨盆倾斜角、双下肢长度差、股骨颈/假体前倾角、髋臼/假体前倾角和联合前倾角的变化。结果:15例DDH患者平均随访(24.53±17.17)个月。Harris评分由术前(49±5.07)分增加至末次随访时的(81.36±11.91)分;术前患肢短缩(58.0±15.38)mm改善为随访时患肢延长(11.78±7.99)mm;骨盆倾斜角由术前3.06°±2.21°减小至随访时1.93°±1.83°;股骨颈前倾角由术前44.77°±11.68°减小至随访时25.25°±8.11°;髋臼前倾角由术前27.84°±9.19°变为随访时14.92°±2.69°;联合前倾角由术前71.81°±14.84°减小至随访时39.45°±7.26°。术后1例发生截骨处骨不愈合,随访时2例患者遗留轻度跛行,无假体松动、下沉及翻修病例。结论:短缩截骨下组配式S-ROM假体联合真臼位全髋关节置换术治疗CroweⅣ型DDH,预后良好。

Background：Due to distorted anatomy of Crowe typeⅣdevelopmental dysplasia of hip （DDH）, total hip arthro-plasty （THA） in these patients represents technically demanding procedure and often gives rise to relatively high rate of complications. Objective：To investigate clinical efficacy of THA with S-ROM prosthesis and anatomic acetabular recon-struction as well as subtrochanteric osteotomy for CroweⅣdevelopmental dysplasia of hip （DDH）. Methods：Fifteen （sev-enteen hips） patients with severe DDH （CroweⅣ） were treated by THA with S-ROM prosthesis and subtrochanteric osteot-omy from February 2011 to October 2015. Harris hip score, pelvic obliquity, limb-length discrepancy, anteversion angles of femoral neck and acetabulum/their prostheses and combined anteversion obtained by clinical observation and radiographic measurements were compared before and after operation. Results： Fifteen patients were followed up for （24.53 ± 17.17） months. Compared with preoperative ones, Harris hip score was significantly increased postoperatively （49±5.07 vs 81.36± 11.91）, limb-length discrepancy significantly improved （shortening [58.0 ± 15.38]mm preoperatively, lengthening： [11.78 ± 7.99] mm postoperatively）, angles of pelvic obliquity, anteversion angles of femoral neck, anteversion angles of acetabulum, and combined anteversion angles were significantly （3.06°±2.21° vs 1.93°±1.83°, 44.77°±11.68° vs 25.25°±8.11°, 27.84°± 9.19° vs 14.92° ± 2.69° , 71.81° ± 14.84° vs 39.45° ± 7.26° ）. Nonunion was found in one patient at the site of osteotomy and slight limping remained in two patients postoperatively. No prosthesis loosening, subsidence or revision occurred. Conclu-sions： It is effective for Crowe Ⅳ DDH treated by THA with S-ROM prosthesis, anatomic acetabular reconstruction and subtrochanteric osteotomy.