Wagner Cone生物柄非股骨截骨全髋关节置换术治疗成人髋关节发育不良

Total hip arthroplasty with uncemented Wagner cone stem and non-femoral osteotomy for developmental dysplasia of hip

目的探讨年轻髋关节发育不良(DDH)患者采用非股骨短缩截骨技术结合Wagner Cone圆锥形生物型先髋柄的全髋关节置换术(THA)及其近期临床疗效。方法 2010年8月至2013年6月间,兰州军区总医院关节外科收治18例(20髋)DDH并发髋关节骨关节炎患者,患者均为女性,年龄22~43岁,平均(27±5)岁。髋关节发育不良按Crowe分型:Ⅲ型7例(7髋),Ⅱ型8例(10髋),Ⅰ型3例(3髋)。术前髋关节功能评分(Harris评分)(52.5±9.2)分,肢体平均短缩(3.2±0.9)cm(1.0~4.5 cm)。所有患者均采用后外侧入路,选择非股骨短缩截骨技术结合Wagner Cone圆锥形生物先髋柄假体进行人工髋关节置换。比较手术前、后的Harris评分并行影像学评估股骨近端髓腔形态与股骨假体的匹配情况,以及术后骨-假体界面稳定性。对术前和术后Harris评分进行t检验,P<0.05为差异有统计学意义。结果平均随访时间为(42±9)个月(20~55个月)。Harris评分从术前(52±9)分提高至末次随访时(90±4)分,组间差异有统计学意义(t=21.2,P<0.01)。术后即刻X线片均显示股骨柄与髓腔紧密压配,假体髓腔填充良好。依Engh骨长入标准(骨性固定、纤维性稳定及假体不稳定),18例20髋均为稳定性骨长入。本组病例无感染、假体松动、假体周围骨折等并发症的发生。结论圆锥形Wagner Cone先髋生物柄可良好充填DDH细小的股骨髓腔,不需要股骨短缩截骨,通过有限软组织松解、撬拨复位实现髋关节复位。圆锥形假体柄设计可方便调整DDH增加的前倾角,柄体表面全涂层处理可保证有效的生物固定长度。

Objective To retrospectively analyze the short-term clinical effects of total hip arthroplasty（THA） with an uncemented Wagner cone stem and non-femoral-shortening osteotomy in treating the young patients with developmental dysplasia of the hip. Methods From August 2010 to June 2013, 18 patients （20 hips） underwent total hip arthroplasty with uncemented Wagner cone stem combined with nofemoral-shortening osteotomy for the young patients with developmental dysplasia of the hip. All the cases were females, aged from 22 to 43 years （average, 27 ± 5 years）. According to Crowe classification, seven cases （ seven hips） were in class m, eight cases （ 10 hips） in class Ⅱ and three cases （three hips） in class I. The leg-length discrepancy was （3.2 ±0. 9 ） cm （range, 1.0 -4. 5 cm） before the operation. All the cases were accomplished through posterolateral approach and the THA was conducted with the uncemented Wagner cone stem combined a procedure of no-femoral-shortening osteotomy. Harris hip score was used to assess the clinical results. The radiographic examination was performed to analyze the morphology of the femoral canal and matching of the femoral prostheses, and evaluate the stability of the prosthesis-bone interface after THA. The t test was performed to analyze Harris swre. Results All the patients were followed up for an average time of （42 ± 9 ） months （range, 20 -55 months）. The Harris hip score was improved from preoperative （52 ± 9 ） to （90 ± 4 ） at the finial follow-up, which shawed significant difference （ t = 21.2 ,P 〈 0.01 ）. The initial postoperative X-ray showed good canal filling in all the femoral canals. No infection or prosthesis loosering was observed. Conclusions Uncemented Wagner cone stem has a good stem-canal matching with small femoral canal in young DDH patients. The THA can be performed with limited soft tissue release and direct leverage using an elevator without femoral shortening osteotomy. The cone femoral stem can allow adjustment of the excessive anteversion in operation.