屈髋屈膝体位在Crowe IV型DDH非短缩截骨全髋置换避免坐骨神经损伤的应用

Aplication of hip and knee flexion for avoiding the injury of sciatic at Crowe IV type DDH arthroplasty with ture acetabulum and non-shorted femur osteotomy

目的探讨发育性髋关节高脱位（Developmental Dysplasia of the Hip，DDH）真臼重建非短缩截骨全髋置换术中避免坐骨神经损伤的有效方法。方法20髋CroweIV型DDH者，采用真臼重建非短缩截骨全髋置换，股骨头旋转中心上移42～68mm（48．65±7．28）mm，术中应用Outside-in全关节囊切除，复位时内收20°，屈髋60°，屈膝90°。复位后外展30°，屈髋60°屈，膝90°。麻醉恢复后，根据患者对患肢远端疼痛和麻木的耐受逐渐伸直。应用Harris评分评估髋关节功能。结果所有病人都获得12～108月随访，最后一次Harris评分（87．3±10．6），术前Harris评分35分（7～58分），术前术后比较有显著性差异。1髋坐骨神经术中损伤，3髋坐骨神经术后损伤，最终神经损伤均完全恢复。结论CroweIV型DDH全髋置换真臼重建非短缩截骨屈髋外展屈膝位能成功减少坐骨神经损伤。

Objective To explore the mothed to oviding the sciatic nerve at arthroplasty of DDH with true acetabulum con- struction and non-shorten femur osteotomy. Metheds 20 hips with Crowe IV type DDH and the rotating center of feramal head were moved up 42 to 68mm （48.65±7.28） mm, who had suffered from the total hip arthroplasty and whose total joint capsule were resected by Outside-in, with ture acetabulum construction and non-shorten femur osteotomy, who had achieved the protection by piriformis or the protection of gauze pad, who were hip adduction at 20°, hip flexion at 60°, and knee flexion at 90° at reduction, who were hip abduction at20°, hip flexion at 60°, and knee flexion at 90° after re- duction, whose affected limb were gradually extended according to the tolerance of patients of distal limb pain and num- bness after anesthesia recovery, and whose function were evaluated by Harris hip score. Results All patients had got follow-up from 12 to 108months. The harris score is （87.3±10.6） at last time and 35 （7 to 58） before operation, and have the significant differences between the preoperative and postoperative. 1 hip suffered from sciatic injury at operation, 3 hips suffered from sciatic injury postoperation, and all got finally nerve injury recovered completely. Conclusion it can decrease the rate of sciatic injury with hip adduction flexion and knee flexion at treatment the Crowe hip adduction at 20°, hip flexion at 60°, and knee flexion DDH with ture acetabulum and non-shorted femur osteotomy.