全髋关节置换术治疗髋臼发育不良经髋臼截骨后骨关节炎

Total hip arthroplasty for osteoarthritis secondary to acetabular osteotomy for developmental dysplasia of hip

[目的]分析全髋关节置换术(total hip arthroplasty,THA)治疗髋关节发育不良经髋臼截骨术后继发髋关节骨关节炎的中期临床和影像学随访结果。[方法]回顾分析2002~2015年因髋关节发育不良经初期髋臼截骨术后继发髋关节骨关节炎(osteoarthritis,OA)的29例患者(29髋)所行单侧THA的结果。手术时患者平均年龄(42.00±13.85)岁(21~64)岁。分析患者手术前后髋关节Harris评分和系列X线片,对临床和影像学效果进行评估。[结果]围手术期并发症包括术后脱位1例、医源性坐骨神经损伤1例以及术中假体周围骨折2例。无需要翻修者。全部患者获得随访,平均随访时间(75.52±51.06)个月(25~188个月)。髋关节Harris评分从术前平均(42.90±12.18)分(16~63分)提高至末次随访的(82.66±5.16)分(76~97分)(P<0.001)。26例(86.66%)患者对手术疗效非常满意或比较满意。[结论]尽管既往髋臼截骨术会对后续的THA治疗造成诸多技术性困难,但采用生物固定型假体对髋臼截骨术后继发髋关节骨关节炎病例进行THA重建的中期临床和影像学结果仍然令人满意,具有较高的患者满意度。

[Objective] To evaluate medium-term clinical and radiographic results of total hip arthroplasty（THA） for osteoarthritis secondary to acetabular osteotomy for developmental dysplasia of hip（DDH）. [Methods] Between 2002 and 2015, 29 patients（29 hips） who had acetabular osteotomy performed previously for DDH underwent THA for the secondary osteoarthritis.The patients aged from 21 to 64 years with an average of（42.00±13.85） years at the THA. The clinical results were evaluated using Harris hip score and radiographic assessment of perioperative serial X-ray films. [Results] In term of perioperative complications, iatrogenic sciatic never injury in 1 patient and periprosthetic fracture in 2 patients happened during the THA, while dislocation in 1 patient occurred postoperatively, which all treated properly without revision surgery. All the patients were followed up for 25 to 188 months with an average of（75.52±51.06） months. The Harris hip score significantly increased from（42.90±12.18） ranged from 16 to 63 preoperatively to（82.66±5.16） ranged from 76 to 97 at the latest follow-up（P〈0.01）. Of them, 26 patients were very satisfied or satisfied to THA results. [Conclusion] Although the reconstruction technique is challenging after previous acetabular osteotomy, the THA is still a reliable option for DDH, with encouraging medium-term clinical and radiographic results and high level of patients＇ satisfaction.