先天性髋关节脱位的全髋关节置换术

Total hip replacement in patients with congenital dislocation of hip

目的了解先天性髋关节脱位患者行全髋关节置换术后的中远期疗效.方法先天性髋关节脱位患者行全髋关节置换术32例36髋,随访28例31髋,随访时间平均9.5年(35～18年).脱位分类:低位脱位或半脱位15髋,中位脱位11髋,高位脱位5髋.固定方法:髋臼侧,10髋为骨水泥固定,21髋为非骨水泥固定;股骨侧,12髋为骨水泥固定,19髋为非骨水泥固定.结果1例术中发生小转子劈裂,1例术后发生下肢静脉炎,3例两侧肢体不等长2 cm以上,1例发生股动脉栓塞.4髋发生假体松动,1髋为大转子不愈合而松动,1髋为单纯假体柄松动,2髋为假体柄和髋臼假体均发生松动;其余27髋Harris评分为85分(术前48分).结论先天性髋关节脱位的全髋关节置换术,手术相对比较复杂,并发症较多,手术中特别需要考虑两侧肢体的长度、外展肌的平衡、软组织的松解、髋臼骨缺损的处理及假体的选择.

Objectiv e To evaluate the mid-term and long-term clinical outcome of total hip re-pl ace ment in patients with hip congenital dislocation.Methods From June198 3to Decem ber1998,36hips in32patients di agnosed as congenital disloca tion of hip(CDH),aged22to69years old(with the mean of 48.5years), were treated with total hip replacement (THR).Thirty-one hips of 28patient s were fol lowed-up with the duration of 9.5years(3.5to18years).Ac c ording to our system,the congen ital dys-pla sia of hip was divid ed into th ree degrees:the first degree was subluxation in15hips,the second degree was in termedi ate dislo cation in11hips,and the third degree was high dislocatio n in5hips.The fixation of the prosthetic compo nents was as follows :10cup s and12stems with cement,21cups and19stems with un-cement.In acetab ula r preparation,most of the patients with subluxation(13hips)underwent deep ening of the acetabu lum and were installed with larger cups;deepening of the acetabulum,smaller cup and auto femoral grafting on the su perior lip fixed w ith screws were performed in2hips with subluxation and all of hips with interm e di ate and high dislocation.Results The complications included intra operativ e lesser trochanter fracture in1case,deep vein thrombosis and thromboembolism of femoral artery in1case re spec-tively,limb discrepancy in3cases,asepti c loosening in4cases(1with trochanteric nonunion and migration,1with stem l oosening and2with both stem and cup loosening).The Harrisscore was85in th e other27hips(48scores before surgery).Con clusion Total hip replacement in patients with congenital dislocation of hip could be some what difficult be cause of the liability to complications.The techni cal difficulties en coun-t ered during surgery in cluded the correction of the length of bilateral lower extremi ty,the balance of the abductor muscles,the re lease of the soft tis sue,the dealing of the su perior segmental defect of acetabulum and selectio n of the compo nents.