组配式人工髋关节系统假体治疗Crowe Ⅳ型髋关节发育不良临床研究

Total hip arthroplasty using the modular prosthesis for Crowe Ⅳ developmental dysplasia of hip

目的探讨组配氏人工髋关节系统（S-ROM,De Puy;S-R,Akon）治疗成人CroweⅣ型先天性髋关节发育不良的外科技术及疗效。方法 2008年3月-2013年12月,收治15例（20髋）CroweⅣ型先天性髋关节发育不良继发骨性关节炎患者,其中男性2例,女性13例;年龄34-64岁,平均49岁。左髋8例,右髋12例。患髋Harris评分（35.79±7.81）分,髋关节活动度（131.74±12.72）°。患肢较健侧短缩4-6 cm,平均5.1cm。X线片示患髋完全性高位脱位。术中采用S-ROM髋关节假体12例,S-R假体3例。结果患者切口均Ⅰ期愈合,无髋关节脱位,术后1例发生坐骨神经损伤。15例均获随访,随访时间2-6年,平均3年。术后半年所有患者均能下地行走,术前跛行步态明显改善,并恢复日常工作。髋关节Harris评分（82.58±4.73）分,与术前比较差异有统计学意义（=46.095,=0.00）;髋关节活动度（215.26±24）°,与术前比较差异有统计学意义（=23.809,=0.00）。X线片复查示,股骨截骨处均在术后3-6个月愈合;股骨假体-骨界面稳固,无松动。随访期间无假体翻修。结论应用组配式人工髋关节系统（S-ROM,De Puy;S-R,Akon）治疗重度髋关节发育不良,尤其是处理股骨近端严重畸形,术中操作方便,术后近期疗效较满意,但假体远期生存率仍需进一步观察。

Objective To study the surgical technique and effect of total hip arthroplasty（THA） using modular prosthesis for Crowe type IV congenital dysplasia of the hip in adults.Methods Between Mar 2008 and Dec 2013,15 adult patients（20 hips） with Crowe type IV congenital dysplasia of the hip underwent THA.They were two men and thirteen women,aged 34 to 64 years with a mean age of 49 years.The left hip was involved in 8 cases and the right hip in 12 cases.The Harris score of involved hip was（35.79±7.81）.The total range of the hip joint movement was（131.74±12.72） °.The shortened length of involved extremity was 4 to 6 cm（mean,5.1 cm）.The X-ray films showed complete dislocation in all cases.The S-ROM femoral prosthesis（12 cases）,S-R（3 cases） femoral prosthesis were used in THA.Results The incisions healed by first intention.There was no hip dislocation events during the follow-up.Siatic nerve injury occurred in 1 case.All the patients were followed up 2 to 6 years（mean,3 years）.All cases showed obvious improvement of claudication and could restore to work.At 6 months after operation,the Harris score was significantly increased to（82.58±4.73）（t=46.095,P=0.00）.The total range of the hip joint movement was（215.26 ±24） °after surgery（t=23.809,P=0.00）.The X-ray showed that all cases got bony union at 3 to 6 months after operation and stable interface between femur prosthesis and bone.No revision was involved during the follow-up.Conclusion THA using the modular prosthesis is an effective method in the treatment of Crowe type IV congenital dysplasia of the hip in adults.The early effectiveness is satisfactory.The long-term survival rate of prosthesis needs to be followed up.