Wagner cone股骨柄联合转子下横形截骨的全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良

Total Hip Arthroplasty With Wagner Cone Stem and Transverse Subtrochanteric Osteotomy in Treatment of Crowe type Ⅳ Developmental Dysplasia of the Hip

目的分析Wagner cone股骨柄联合转子下横形截骨的全髋关节置换术治疗CroweⅣ型髋关节发育不良患者的临床结果和并发症。方法回顾性分析2009年1月至2015年12月在新疆医科大学第一附属医院关节外科,应用Wagner cone股骨柄联合转子下横形截骨的全髋关节置换术治疗51例(67髋)CroweⅣ型髋关节发育不良患者,其中男7例,女44例;年龄16～65岁,平均年龄40岁;双髋患者16例,单髋患者35例。应用Harris髋关节评分评价患者临床功能恢复情况,根据骨盆X线片、双下肢全长片评价假体位置、截骨处愈合情况、有无骨溶解、假体下沉等。结果患者随访时间24～108个月,平均随访时间54个月。患者Harris髋关节评分由术前平均37.5分(30～55分)增至术后平均85.8分(78～96分),手术前后Harris髋关节评分比较差异有统计学意义(P<0.05)。术前肢体长度差异平均3.8cm(0～8cm),术中截骨长度平均3.1cm(1.5～6.5cm),术后肢体长度差异平均0.8cm(0～1.5cm)。术中骨折3例(3髋),截骨处未愈合1例(2髋),术后脱位5例,无感染、神经损伤和假体松动、下沉。结论 Wagner Cone股骨柄联合转子下横形截骨的全髋关节置换术治疗CroweⅣ型髋关节发育不良患者,临床疗效满意,术后并发症少,可有效平衡双下肢长度,简化手术的复杂性,值得临床推广使用。

Objective To analyze the clinical outcome and complications of total hip arthroplasty(THA)with Wagner Cone stem and transverse subtrochanteric osteotomy in treatment of Crowe type iv Developmental Dysplasia of the Hip(DDH).Methods 51 patients(67 hips)underwent THA with Wagner Cone stem and transverse subtrochanteric osteotomy from January,2009 to December,2015 were included in our study.There were 44 women and 7 men.The age was 16 to 65,with an average age of 40 years.All the patients were diagnosed as Crowe typeⅣDDH.The clinical function of the patients was evaluated by Harris Hip joint score and AP pelvic view and full-length view of the lower extremities were used to evaluate the position of prosthesis,the healing of osteotomy,the osteolysis and the sinking of prosthesis.Results The average duration of follow-up was 54 months(Range 24~108 months).The mean Harris hip score was improved from 37.5(range:30~55)preoperatively to 85.8 postoperatively(range:78~96),and there were statistically significant differences in Harris hip score(P<0.05).Mean leg-length discrepancy had decreased from 3.8 cm(range,0~8 cm)preoperatively to 0.8 cm(range,0~1.5 cm)by the latest follow-up evaluation.Femoral shortening subtrochanteric osteotomy was performed with an average femoral resection of 3.1 cm(range:1.5~6.5 cm).There were 3 cases of intraoperative fracture,5 cases of postoperative dislocation,1 case of nonunion(2 hips),without infection,nerve palsy,prosthesis loosening and sinking.Conclusion Total hip arthroplasty with Wagner Cone stem and transverse subtrochanteric osteotomy for CroweⅣdevelopmental dysplasia of the hip can obtain satisfactory clinical outcomes with less complications and effectively balance the length of two lower limbs and simplify the complexity of the operation.