全髋关节置换术治疗成人髋关节发育不良骨缺损的疗效

The effect of total hip arthroplasty in the treatment of development dysplasia of the hip with bone defect in adult

目的 探讨全髋关节置换术(THA)治疗成人髋关节发育不良(DDH)骨缺损的临床效果。方法 采用THA治疗42例DDH骨缺损患者(42髋),术中行生物型髋臼杯联合髋臼外上方结构性植骨。按照Crowe分型将患者分为CroweⅢ型组(25例)和CroweⅣ型组(17例)。记录并比较两组手术情况、临床疗效评价指标及影像学评估指标。结果 患者均获得随访,时间1~2年。(1)手术时间、术中出血量、术后引流量:CroweⅢ型组均明显短(少)于CroweⅣ型组(P<0.001);髋臼杯直径:CroweⅢ型组明显大于CroweⅣ型组(P<0.05)。(2)术后6个月双下肢长度差和末次随访时Harris评分:两组均明显优于术前(P<0.05),CroweⅢ型组均明显优于CroweⅣ型组(P<0.05)。(3)两组髋臼杯均安放于真臼或接近真臼,髋臼杯覆盖率均为100%。(4)术后3 d髋关节旋转中心高度、髋关节旋转中心水平距离:两组均明显低于术前(P<0.05);CroweⅢ型组均明显低于CroweⅣ型组(P<0.05)。(5)宿主骨覆盖率及植骨块覆盖率:CroweⅢ型组均明显高于CroweⅣ型组(P<0.001)。结论 采用THA治疗成人DDH骨缺损,术中行生物型髋臼杯联合髋臼外上方结构性植骨,移植骨块可与髂骨逐渐融合并完成重建,可获得满意的临床疗效和影像学结果,且CroweⅢ型较CroweⅣ型的治疗效果更好。

Objective To investigate the clinical effect of total hip arthroplasty(THA) in the treatment of development dysplasia of the hip(DDH) with bone defect in adult.Methods The 42 patients(42 hips) of DDH with bone defects were treated by THA,during surgery,biological acetabular cup combined with acetabular lateral and superior structural bone grafting were performed. According to Crowe classification,the patients were divided into Crowe typeⅢ group(25 cases) and Crowe type Ⅳ group(17 cases). The operation conditions,clinical efficacy evaluation indexes and imaging evaluation indexes of the two groups were recorded and compared.Results All patients were followed up for 1 ~ 2 years.(1) Operative time,intraoperative blood loss and postoperative drainage volume:Crowe typeⅢ group were significantly shorter(less) than Crowe type Ⅳ group(P< 0. 001). The diameter of acetabular cup in Crowe type Ⅲ group was significantly larger than that in Crowe type Ⅳ group(P < 0. 05).(2) The difference of lower limbs length at 6 months after surgery,Harris score at the last follow-up:both groups were significantly better than those before surgery(P< 0. 05),Crowe type Ⅲ group was significantly better than Crowe type Ⅳ group(P< 0. 05).(3) The acetabular cups were all placed in the true socket or close to the true socket in both groups,and the acetabular cup coverage rate was 100% .(4) At 3 d postoperation,the height and horizontal distance of hip rotation center were significantly lower in both groups than before surgery(P< 0. 05);which of Crowe type Ⅲ group were significantly lower than Crowe type Ⅳ group(P< 0. 05).(5) The coverage rate of host bone and bone graft in Crowe type Ⅲ group were significantly higher than those in Crowe type Ⅳ group(P< 0. 001).Conclusions THA is used to treat DDH with bone defects in adult. During the operation,the cementless acetabular cup is combined with the lateral and superior structural bone grafting of the acetabulum. The grafted bone can gradually fuse with the iliac bone and complete the reconstruction. Satisfactory clinical efficacy and imaging results can be obtained. The therapeutic effect of Crowe type Ⅲ group is better than that of Crowe type Ⅳ group.