股骨转子下截骨联合人工全髋关节置换术治疗Crowe Ⅳ型先天性髋关节发育不良中期疗效

Mid-term effectiveness of total hip arthroplasty with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of hip

目的探讨采用股骨转子下截骨联合人工全髋关节置换术(total hip arthroplasty,THA)治疗CroweⅣ型先天性髋关节发育不良(developmental dysplasia of the hip,DDH)的中期疗效。方法 2009年9月—2014年3月,采用股骨转子下截骨联合THA治疗49例(57髋)CroweⅣ型DDH患者。其中男7例,女42例;年龄20~73岁,平均44.6岁。左髋26例、右髋15例;双髋8例。术前髋关节Harris评分(44.68±3.39)分,双下肢不等长(5.27±0.55)cm。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间32~87个月,平均52.1个月。末次随访时,Harris评分为(85.67±2.89)分,较术前显著提高(t=–69.53,P=0.00);双下肢不等长(1.12±0.48)cm,与术前比较差异有统计学意义(t=42.94,P=0.00)。术后6个月X线片复查示,截骨端均愈合良好;末次随访复查示假体无松动、下沉。结论采用股骨转子下截骨联合THA治疗CroweⅣ型DDH,可降低关节周围血管神经牵拉损伤风险,中期疗效较好。

Objective To explore the mid-term effectiveness of total hip arthroplasty （THA） with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip （DDH）. Methods Between September 2009 and March 2014, a total of 49 patients （57 hips） who were diagnosed with Crowe type IV DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years （range, 20-73 years）. The preoperative Harris score was 44.68%3.39 and the preoperative leg length discrepancy was （5.27±0.55） cm. Results All incisions healed primarily. All patients were followed up 32-87 months （mean, 52.1 months）. At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was （1.12±0.48） cm, showing significant differences when compared with the preoperative values （t=-69.53, P=0.00; t=42.94, P=0.00）. X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up. Conclusion The subtrochanteric shortening osteotomy with THA in treatment of Crowe type iv DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.