Wagner Cone非骨水泥股骨柄联合转子下短缩截骨治疗成人Hartofilakidis Ⅲ型发育性髋关节发育不良

Clinical effect analysis of Wagner Cone uncemented femurol stem and subtrochanteric osteotomy used in adult Hartofilakidis Ⅲ DDH patients

目的探讨Wagner Cone非骨水泥股骨柄治疗成人Hartofilakidis Ⅲ型发育性髋关节发育不良(developmental dysplasia of the hip, DDH)的临床疗效。方法回顾性分析2009年1月至2016年12月间在我院接受Wagner Cone非骨水泥股骨柄联合转子下短缩截骨全髋关节置换术(total hip arthroplasty,THA)的69例(81髋)成人高位DDH病人的临床资料。其中,女58例,男11例,平均年龄为35.4岁(16~65岁),均为Hartofilakidis Ⅲ型DDH。临床主要症状为:患髋疼痛,不等长,跛行。双下肢长度平均差值为4.1 cm,平均脱位高度为5.8 cm。均采用股骨小转子下短缩截骨,臼杯均安装于真臼处,臼杯骨量覆盖80%以上。随访观察截骨处的愈合情况、患肢长度及并发症,采用髋关节Harris评分标准评定患肢功能。结果平均随访4.5年(1.5~9.0年)。临床疼痛症状缓解,双下肢长度的平均差值降至1.1 cm。1例术中股神经不全损伤(术后4个月恢复),截骨近端上移4例,截骨远端骨折1例,远端松动旋转移位2例,术后截骨端不愈合或延迟愈合5例,术后脱位2例,血栓2例,术后感染1例。病人髋关节功能较术前明显改善,Harris评分由术前的(30.4±4.3)分提高至(86.3±6.3)分,差异有统计学意义(t=5.836,P=0.031)。结论对于HartofilakidisⅢ型DDH病人,Wagner Cone非骨水泥股骨柄联合转子下短缩截骨治疗可有效平衡双下肢长度,缓解患髋疼痛,而且操作简单,并发症较少,可以获得满意的临床效果。

Objective To analyze the clinical effects of Wagner Cone uncemented femurol stem used in adult patients with Hartofilakidis Ⅲ developmental dysplasia of the hip （DDH）. Methods We retrospectively analyzed the data of 69 cases of high developmental dislocation of the hip （DDH） （81 hips）, including 58 females and 11 males with mean age of 35.4 years old （range, 16-65） who had undergone total hip arthroplasty （THA） at a single center from January 2009 to November 2009. All patients were fallen into Hartofilakidis Ⅲ DDH. The main clinical symptoms were： hip pain, unequal leg length, and claudication. The average unequal leg length was 4.1 cm, and average dislocation height was 5.8 cm. Short reduction and osteotomy were performed under the small trochanter of the femur. All the acetabular cups were installed at the true acetabulum, and more than 80% of the host acetabular bone was covered for THA. The healing of the osteotomy, leg length and the complications were collected, and the function of the affected limb was assessed by Harris hip score. Results The mean follow-up was 4.5 years （1.5-9.0 years）. The average difference of the length of the lower limbs decreased to 1.1 cm after the relief of clinical pain. Incomplete injury of femoral nerve occurred in 1 case （recovery after 4 month）, proximal femoral osteotomy side removed in 4 cases, distal femoral osteotomy side fracture in 1 case, stem loosening in 2 cases, postoperative osteotomy nonunion or delayed union in 5 cases, postoperative dislocation in 2 cases, thrombosis in 2 cases, and postoperative infection in 1 case. Hip function was improved significantly after operation as compared with preoperation on Harris score （increased from 30.4±4.3 to 86.3±6.3）. Conclusion For Hartofilakidis type Ⅲ DDH patients, Wagner Cone uncemented femurol stem can effectively balance the length of lower limbs, release hip pain, and make the operation simple. The incidence of complications is low, and clinical results are satisfactory.