成人Crowe III型DDH全髋关节置换术的髋臼重建方法探究

ACETABULAR RECONSTRUCTION METHODS IN TOTAI HIP ARTHROPIASTY FOR PATIENTSWITH CROWE TYPE-III DEVEIOPMENTAI DYSPIASIA

目的：探讨成人Crowe III型先天性髋关节发育不良（developmental dysplasia of the hip,DDH）全髋关节置换术（total hip arthroplasty,THA）中髋臼重建方法及临床疗效.方法：我院从2008年1月~2014年7月期间接受全髋关节置换的成人Crowe III型DDH患者40例（45髋）.男性8例,女性32例,年龄31~68岁,平均51.4岁.临床症状主要表现为患髋疼痛、功能受限、跛行等.采用真臼重建、加深髋臼、旋转中心内移和下移,辅以自体颗粒骨打压植骨的髋臼重建方法.术后随访髋关节功能（Harris评分）、肢体长度、旋转中心位移、假体覆盖率、髋关节放射X片、并发症等. 结果：术后平均随访32.7个月,术后无假体周围感染、松动、脱位等并发症,末次随访髋关节假体稳定,无螺钉断裂,假体周围未见透亮线及植骨骨吸收等.所有病例髋臼旋转中心都接近正常,患侧肢体长度平均延长约2.31±0.18cm,假体覆盖率平均79.6%.术后旋转中心的水平距离3.10±0.38cm,垂直距离2.13±0.17cm,髋关节Harris评分由术前49.11±7.30分上升至末次随访89.13±2.91分,与术前比较差异均有统计学意义（P〈0.01）. 结论：采用真臼重建、加深髋臼、旋转中心内移和下移,辅以自体颗粒骨打压植骨的髋臼重建方法在成人Crowe III型DDH患者全髋关节置换术中,可有效恢复髋臼覆盖率,维持臼杯初始稳定性并增加骨储备量,近期疗效满意.

Objective：To investigate the method and the clinical effect of the acetabular reconstruction in total hip arthroplasty （THA） for Crowe type-III developmental dysplasia of the hip in adult.Methods：From January 2008 to July 2014, THA procedures were performed in 40 patients with 45 hips, including 8 males and 32 females, with the average age of 51.4 years （ranging from 31 years to 68 years）.all patient is of Crowe type-III developmental dysplasia of the hip in adult.All patient experienced severe pain and claudication.These Patients were treated with THA involving reconstruction at the anatomic acetabulum, acetabulum deepening technique, medialization and distalization of the centre of rotation and impaction grafting with autogenous bone particles.The patients were all followed up and evaluated with Harris score, limp length, Displacement of the centre of rotation, cup coverage, X radiographic examination and postoperative complications.Results：The average period of follow-up was 32.7 months.Acetabular rotating center of all the cases was back to normal and the mean cup coverage was 79.6%.The average leg length was increased for （2.31 0.18） cm, The postoperative horizontal and vertical distance of the hip center were （3.10 0.38） cm and （2.13 0.17） cm, the mean Harris score was improved from preoperative （49.11 7.30） points to （89.13 2.91） points at the latest follow-up, showing statistically significant difference （p〈0.01）.There were no postoperative complications such as infection, dislocation, prosthesis loosening happened.no radiolucent lines, screw fracture, bone graft absorption were detected at the latest follow-up.Conclucsions：During the total hip arthroplasty for the treatment of Crowe type-III DDH, reconstructing the acetabular at the anatomic acetabulum, deepening the acetabulum, putting the cup medially and distally combined with Autogenous impaction grafting can effectively restore the acetabular coverage, maintain the stability of acetabular cup and provide better relative bone stock, the short-term effect were satisfactory.