两种截骨全髋置换术治疗Crowe Ⅳ型髋发育不良

Two osteotomies in of total hip arthroplasty for Crowe typeⅣdevelopmental dysplasia of the hip

[目的]比较转子下截骨与大转子截骨全髋关节置换(THA)术治疗CroweⅣ型先天性髋关节发育不良的临床效果。[方法]2013年11月~2019年11月本院收治的60例(64髋)CroweⅣ型先天性髋关节发育不良患者,所有患者依据实际病情与个人意愿选择截骨方式,依据截骨方式分为转子下截骨组32例(34髋)和大转子截骨组28例(30髋)。转子下截骨组接受转子下截骨THA,大转子截骨组采取大转子截骨THA。比较两组患者围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,两组患者手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05)。术前两组患者双侧肢体长度差差异无统计学意义(P>0.05),术后两组双侧肢体长度差均较术前显著减小(P<0.05);术后各时间点,转子下截骨组双侧肢体长度差值显著大于大转子截骨组(P<0.05)。手术前两组患者Harris评分差异无统计学意义(P>0.05),术后两组患者Harris评分均较术前显著提高(P<0.05);相同时间转子下截骨组的Harris评分均高大转子截骨组,但差异无统计学意义(P>0.05)。转子下截骨组总并发症发生率为4/32(12.50%),大转子截骨组为4/28(14.28%),差异无统计学意义(P>0.05)。术后两组间假体旋转中心至泪滴的水平距离(HDRT)和垂直距离(VDRT)差异无统计学意义(P>0.05);而大转子截骨组假体旋转中心至转子尖的垂直距离(VDRG)显著小于转子下截骨组(P<0.05),大转子截骨组假体旋转中心至转子尖的水平距离(HDRG)显著大于转子下截骨组(P<0.05)。[结论]两种截骨术实施人工全髋关节置换术均能有效处理CroweⅣ型先天性髋关节发育不良,但转子下截骨术可能减少并发症,取得更好的临床效果。

[Objective]To compare the clinical outcomes of subtrochanteric osteotomy(STO)versus greater trochanter oste otomy(GTO)in total hip arthroplasty for Crowe typeⅣdevelopmental dysplasia of the hip(DDH).[Methods]A total of 120 pa tients who were undergoing THA for Crowe typeⅣDDH were enrolled into this study from May 2014 to May 2017 in our hospi tal,and randomly divided into the STO group and GTO group,with 60 cases in each group.The perioperative,follow up and ra diographic documentations were compared between the two groups.[Results]All the patients in both groups had operation per formed with no statistically significant differences in operation time,intraoperative blood loss and hospital stay between the two groups(P>0.05).Regardless of no a statistical difference before operation between them(P>0.05),the discrepancies of low extremity lengths in the STO group were significantly greater than the GTO group at all time points after operation(P<0.05),which significantly decreased in both groups over time postoperatively(P<0.05).In addition,the Harris scores significantly increased at all time points postoperatively compared with those before operation,and continuously increased over time after operation in both group(P<0.05).The STO group got higher Harris scores than the GTO group at all time points postoperatively,although no significant differences were proved between them(P>0.05).Furthermore,the total postoperative complication rate was of 8/60(13.33%)in the STO group,whereas 11/60(18.33%)in the GTO group,regardless of no a statistical significance(P>0.05).[Conclusion]The THA with both subtrochanteric osteotomy and greater trochanteric osteotomy do effectively treat Crowe typeⅣDDH.By comparison,the subtrochanteric osteotomy might have advantages of reducing complication and improving functional outcomes.