CroweⅣ型发育性髋关节发育不良人工全髋关节置换术中三种截骨断端固定方式的比较研究

A comparative study of three different fixation methods after subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe typeⅣdevelopmental dysplasia of the hip

目的比较CroweⅣ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)人工全髋关节置换术(total hip arthroplasty,THA)中,股骨转子下短缩截骨术(subtrochanteric shortening osteotomy,SSO)后3种固定方式固定截骨断端的疗效差异。方法回顾分析2014年11月—2019年5月63例(78髋)因CroweⅣ型DDH行THA联合SSO患者临床资料,其中18例(20髋)截骨后依靠股骨假体髓内压配进行固定(A组);22例(30髋)在截骨后、植入假体前,采用钢丝对股骨进行预防性捆绑固定(B组);23例(28髋)截骨后将截下的骨块覆盖于截骨部位,并辅以钢丝或钛缆固定(C组)。3组患者性别、年龄、身体质量指数、患肢侧别以及术前Harris评分等一般资料比较,差异均无统计学意义(P>0.05)。记录并比较3组手术时间、并发症发生情况、影像学检查结果以及髋关节功能评分。结果3组手术时间比较差异无统计学意义(P>0.05)。术后切口均Ⅰ期愈合。3组患者均获随访,A组随访时间2.5~4.0年,平均3.1年;B组1.5~5.5年,平均3.2年;C组1.0~5.0年,平均1.6年。术后4、12个月3组间Harris评分以及西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分比较,差异均无统计学意义(P>0.05)。X线片复查显示3组截骨均愈合,3组间愈合时间以及术后4、8、12个月截骨愈合率比较,差异均无统计学意义(P>0.05)。B组1髋术中发生股骨远端骨折,无关节脱位、假体松动、假体周围关节感染以及异位骨化等并发症发生。结论CroweⅣ型DDH患者THA术中SSO后,与仅采用股骨假体髓内压配固定相比,钢丝预防性捆绑及自体骨块辅以钢丝或线缆捆绑不能显著促进截骨愈合。但对于截骨断端髓腔不匹配者,建议选择自体骨辅以线缆固定。

Objective To compare the effectiveness of three different fixation methods after subtrochanteric shortening osteotomy(SSO)in total hip arthroplasty(THA)for Crowe typeⅣdevelopmental dysplasia of the hip(DDH).Methods A clinical data of 63 patients(78 hips)with Crowe typeⅣDDH,who underwent THA with SSO between November 2014 and May 2019,was retrospectively analyzed.Among them,18 patients(20 hips)obtained stability by intramedullary pressure provided by the S-ROM modular prostheses(group A);22 patients(30 hips)underwent prophylactic binding by stainless steel wire after osteotomy and before stem implantation(group B);23 patients(28 hips)were fixed with autogenous cortical strut grafts and stainless steel wire or cables(group C).There was no significant difference in gender,age,body mass index,affected limb side,and preoperative Harris score between groups(P>0.05).The operation time,complications,imaging results,hip functional score of the three groups were recorded and compared.Results There was no significant difference in the operation time between groups(P>0.05).All incisions healed by first intention.All patients were followed up,and the follow-up time was 2.5-4.0 years(mean,3.1 years)in group A,1.5-5.5 years(mean,3.2 years)in group B,and 1.0-5.0 years(mean,1.6 years)in group C.There was no significant difference in Harris score or Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score between groups at 4 and 12 months after operation(P>0.05).X-ray films showed that there was no significant difference in osteotomy healing rate at 4,8,and 12 months after operation and the osteotomy healing time between groups(P>0.05).There was no complications such as joint dislocation,prosthesis loosening,prosthetic joint infection,or heterotopic ossification during follow-up,except for the distal femoral fracture of 1 hip during operation in group B.Conclusion In THA for patients with Crowe typeⅣDDH,the stainless steel wire binding alone and autogenous cortical strut grafts combined with stainless steel wire or cable binding can not significantly promote the osteotomy healing compared with femoral prosthesis intramedullary compression fixation.For patients with nonmatched medullary cavity after SSO,it is recommended to apply autogenous cortical strut grafts with wire or cables for additional fixation.