人工全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良术中应用粗隆下截骨的相关研究

A study of total hip arthroplasty with subtrochanteric osteotomy in Crowe type Ⅳ developmental dysplasia of hip

目的探讨CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)人工全髋关节置换术(total hip arthroplasty,THA)术中应用粗隆下截骨的临床效果。方法回顾分析2008年4月—2016年6月采用THA治疗的71例单侧CroweⅣ型DDH患者临床资料,其中44例术中行粗隆下截骨(截骨组),27例未行粗隆下截骨(未截骨组)。两组患者性别、年龄、体质量、身高、体质量指数、侧别以及术前Harris评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术相关并发症发生情况,采用Harris评分评价髋关节功能。于手术前后摄骨盆正位X线片,测量术前股骨脱位高度和术后SROM近端假体植入深度。结果截骨组随访时间12~90个月,平均34.77个月;未截骨组为12~79个月,平均34.33个月;两组比较差异无统计学意义(t=–0.088,P=0.930)。截骨组术中及术后共11例发生并发症,其中1例因感染致截骨处不愈合,于术后20个月行翻修手术;未截骨组术后3例发生并发症。两组患者假体位置良好、无松动,无关节脱位。两组术前股骨脱位高度及SROM近端假体植入深度比较差异均有统计学意义(t=–8.452,P=0.000;t=6.783,P=0.000);截骨组患者SROM近端假体植入深度与截骨长度无相关(r=–0.038,P=0.806)。末次随访时,截骨组及未截骨组Harris评分比较差异无统计学意义(t=–1.160,P=0.254)。结论 CroweⅣ型DDH患者THA术中应用粗隆下截骨可以获得良好的临床效果,术前股骨脱位较高和股骨近端髓腔严重狭窄的患者更倾向于术中行粗隆下截骨。

Objective To evaluate the effectiveness of total hip arthroplasty （THA） combined with subtro- chanteric osteotomy in the treatment of Crowe type IVdevelopmental dysplasia of the hip （DDH）. Methods Between April 2008 and June 2016, 71 patients with unilateral Crowe type IV DDH were treated with THA. Of 71 cases, 44 were performed with subtrochanteric osteotomy （osteotomy group） and 27 were performed without subtrochanteric osteotomy （non-osteotomy group）. There was no significant difference in gender, age, body mass, height, body mass index, affected side, and preoperative Harris score between 2 groups （P〉0.05）. The complications were recorded and the effectiveness was assessed by Harris score. Besides, the femoral dislocation height and the settling depth of sleeve were measured in the pelvic anteroposterior X-ray film pre- and post-operatively. Results Osteotomy group was followed up 12-90 months （mean. 34.77 months）, and non-osteotomy group was followed up 12-79 months （mean, 34.33 months）. There was no significant difference in follow-up time between 2 groups （t=-0.088, P-0.930）. There was 11 cases of intraoperative or postoperative complications in osteotomy group, and 3 cases of postoperative complications in non-osteotomy group. Among the osteotomy group, 1 case had nonunion due to infection and received revision after 20 months. No loosening or dislocation of the implant occurred in both 2 groups. Significant differences were found in femoral dislocation height and settling depth of sleeve between 2 groups （t=8.452, P=0.000; t=6.783, P=-0.000）. Moreover, the osteotomy length was not correlated with the settling depth of sleeve （r=-0.038, P=0.806）. At last follow-up, there was no significant difference in Harris score between 2 groups （t=-l.160, P=0.254）. Conclusion THA combined with subtrochanteric osteotomy can provide a favorable outcome for treating Crowe type IV DDH. Furthermore, patients with higher femoral dislocation and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.