髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良的对比研究

The comparative study between restoration and proximal reconstruction of hip center for type Ⅱ/Ⅲ developmental dysplasia of the hip

目的比较全髋关节置换术(total hip arthroplasty,THA)中行髋臼原位重建及高髋关节中心技术治疗Crowe Ⅱ、Ⅲ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的临床疗效。方法对2012年8月至2015年12月于我科行THA治疗Crowe Ⅱ、Ⅲ型DDH合并髋关节骨性关节炎(Tonnis Ⅲ期)的37例病例进行回顾性分析,根据髋臼重建方式分组:其中髋臼原位重建组17例,高髋关节中心重建组20例。比较两组病人的手术时间、手术出血量、Harris评分、影像学假体松动率。结果37例病人平均随访41个月(25~63个月)。髋臼原位重建组的手术时间和手术出血量分别为(119±16)min、(413±36)ml,高髋关节中心重建组的手术时间和手术出血量分别为(92±21)min、(389±44)ml,两组间比较,差异均有统计学意义(t=29.561,P=0.021;t=0.682,P=0.231)。两组术后的Harris评分均较术前显著提高,但两组间术前及末次随访的Harris评分比较,差异均无统计学意义(P均>0.05)。髋臼原位重建组中有2例少量植骨吸收,两组随访未见影像学假体松动。结论高髋关节中心技术的手术时间较髋臼原位重建更短,两种技术治疗Crowe Ⅱ、Ⅲ型DDH的中期临床疗效较好,均可显著恢复病人的髋关节功能。

Objective To compare the clinical outcomes of restoration and proximal reconstruction of hip center in total hip arthroplasty （THA） for type Ⅱ/Ⅲ developmental dysplasia of the hip （DDH）. Methods We reviewed 37 patients with type Ⅱ/Ⅲ DDH and osteoarthritis （Tonnis Ⅲ） who were treated with THA between August 2012 to December 2015 in our department. There were 17 cases in restoration of hip center group, and 20 cases in high hip center group. The operative time, operative blood loss, Harris score and radiographic prosthetic loosening rate were recorded and analyzed. Results The mean follow-up time was 41 months （range, 25-63 months）. The operative time and bleeding volume of the restored hip center group were （119±16） min and （413±36） ml respectively, and those were （92±21） min and （389±44） ml respectively in the high hip center group. The differences were statistically significant （t=29.561, P=0.021; t=0.682, P=0.231）. The Harris scores of the two groups at the last follow-up were significantly higher than those before operation, however, there was no significant difference between the two groups preoperatively and postoperatively. No prosthetic loosening was found in two groups. Conclusion In THA dealing with type Ⅱ/Ⅲ DDH, high hip center technique can provide shorter operative time than the restoration of the hip center, and there were no significantly differences in follow-up clinical outcome between two techniques.