髋臼-股骨联合前倾角在Ⅳ型DDH非截骨全髋关节置换术中的应用

The therapeutic effects of total hip arthroplasty with combined anteversion angle of femoral neck-acetabulam in Crowe Ⅳ developmental dysplasia of the hip

目的探讨髋臼-股骨联合前倾角在Ⅳ型成人髋关节发育不良(DDH)患者行非截骨全髋关节置换(THA)术中的作用。方法回顾性分析2013年6月至2016年2月接受Wagner Cone生物柄非截骨全髋关节置手术治疗的45例Ⅳ型DDH患者资料,其中男20例,女25例,CT测量术前及术后髋臼、股骨颈前倾角,X线测量术后髋臼外展角、小转子移位程度及髋关节旋转中心位置,采用Harris评分对髋关节进行功能评分。结果所治患者随访时间1~4年,平均(3.2±0.8)年,截至随访终点无翻修或影像学松动病例,术前髋臼、股骨及髋臼-股骨联合前倾角分别为(27.70±5.35)°、(47.76±7.25)°、(74.90±8.43)°,术后髋臼、股骨及髋臼-股骨联合前倾角分别为(19.82±2.41)°、(23.35±3.84)°、(44.90±5.18)°,两组比较,具有明显差异(P<0.05);术前股骨头脱位高度平均为(5.8±1.2)cm,术后小转子相对移位距离平均为(3.6±0.8)cm;Harris髋关节评分由术前(46.66±7.28)分提高至末次随访(90.36±4.72)分,两者差异有统计学意义(P<0.05),术后髋关节疼痛明显改善,肢体活动度增加,步态接近正常,2例有术后股神经牵拉损伤,未行特殊处理,术后3个月完全恢复正常。结论对于Ⅳ型DDH患者髋臼-股骨联合前倾角可有效的评估术前髋关节畸形程度和术后假体稳定性及匹配程度,Wagner Cone生物柄在非截骨全髋关节置换术中能有效的维持髋关节稳定。

Objective To evaluate the clinical efficacy of combined anteversion angle of femoral neck-acetabulam in Crowe Ⅳ developmental dysplasia of the hip（DDH）with Wagner Cone total hip arthroplasty.Methods From June 2013 to February 2016,45 cases of Crowe Ⅳ DDH were treated with no femoral shorteningosteotomy in THA,including 25 females and 20 males. The outcomes of anteversion angle of femoral neck andacetabulam were measured in CT scan of hip jiont. The outcomes of abduction angle,hip center were measuredradiologically in X-ray of pelvis. Postoperative function was scored by Harris scoring system. Results The meanfollow-up time of the 45 patients was（3.2 ± 0.8）years. Using loosening or revision as the end point,the survivalrate was 100%. The outcomes of preoperative anteversion angle of acetabulam,femoral neck,acetabulam-femoralneck was（27.70 ± 5.35）°,（47.76 ± 7.25）°,and（74.90 ± 8.43）° in Crowe Ⅳ group,and those of postoperativeanteversion angle was（19.82 ± 2.41）°,（23.35 ± 3.84）° and（44.90 ± 5.18）°,respectively. There was significantdifference between the two groups（P 0.05）. The average height of preoperative dislocation in femoral head was（5.8 ± 1.2）cm and the postoperative average displacement of femoral lesser trochanter was（3.6 ± 0.8）cm. TheHarris hip score was improved from preoperative（46.66 ± 7.28）to（90.36 ± 4.72）. For most patients,hip painwere significantly relieved,range of motion of the hip was improved,and the gait returned to normal. Femoralnerve injury occurred in 2 cases and the case recovered after 3 months respectively. Conclusions The deformityof hip and the stability and matching degree of the prosthesis was evaluated with the combined anteversion angle offemoral neck-acetabulam in Crowe Ⅳ DDH. The Wagner Cone can effectively maintain the stability of the hip jointin the non-amputated total hip replacement.