全髋关节置换术合并软组织松解治疗重度发育性髋关节脱位的临床效果

Total hip arthroplasty with soft tissue release for patients with severe development dysplasia of the hip

目的:探讨运用软组织松解和真臼重建的全髋关节置换术治疗重度发育性髋关节脱位伴骨性关节炎的临床疗效。方法:回顾性分析2005年1月至2011年1月21例(23髋)Crowe III型发育性髋关节脱位伴骨性关节炎的患者行合并软组织松解和真臼重建的全髋关节置换术的临床疗效,其中女18例,男3例,年龄(45.1±13.2)岁。2例行双侧全髋关节置换术,19例行单侧全髋关节置换术。术前Harris评分为39.7±5.6。结果:术后随访(110±46)个月,关节痛症状明显缓解。所有患者在软组织切断松解后,股骨头均复位于真臼部位。术后有1例患者出现坐骨神经刺激症状,术后3个月内恢复正常,术后肢体不等长长度(11.0±3.5)mm。术后Harris评分为87.2±5.9。结论:运用软组织松解和真臼重建的全髋关节置换术是治疗重度发育性髋关节脱位伴骨性关节炎的有效方法,但手术难度较大,需要术前制定细致周密的治疗方案。

Objective： To explore the clinical effect of total hip replacement with soft tissue release and true acetabulum reconstruction on treating osteoarthritis secondary to severe development dysplasia of the hip. Methods： From January 2005 to January 2011, 23 hips in 21 patients with o steoarthritis secondary to Crowe III development dysplasia of the hip underwent total hip arthroplasty with soft tissue release and true acetabulum reconstruction. There were 18 females and 3 males. The age was （45.1±13.2） years. Two patients underwent bilateral total hip arthroplasty （THA） and 19 cases underwent unilateral hip. The Harris hip score was 39.7±5.6. Results： The duration of follow up was （110±46） months. The symptoms of patients were relieved, and all the patients＇ femur head recovered to the true acetabulum after soft tissue released. Sciatic nerve paralysis occurred in one patient, who recovered after 3 months. All patients showed restoration of limb length, while the limb-length discrepancy was （11.0±3.5） mm. The post- operation Harris hip score was 87.2±5.9. Conclusion： Total hip arthroplasty with soft tissue release and true acetabulum reconstruction was an effective method in treating osteoarthritis secondary to Crowe III development dysplasia of the hip and was a challenging work to the orthopedic surgeon. It was critical the surgeon to plan the operative intervention carefully.