一期双髋全髋关节置换治疗成年髋关节发育不良继发Crowe Ⅳ型骨性关节炎

Study of bilateral total hip arthroplasty in one-stage treatment of osteoarthritis secondary to Crowe Ⅳ adult developmental dysplasia of the hip

目的探讨一期双侧髋关节全髋置换(THA)治疗髋关节发育不良(DDH)继发CroweⅣ型骨关节炎的临床疗效。方法回顾性分析2009年1月至2014年12月柳州人民医院骨科收治的43例双侧CroweⅣ型髋关节DDH患者的临床资料。患者术前均行X线、CT、MRI检查、评估,采用一期手术治疗,按照严重程度先重后轻的顺序进行双侧髋关节全髋关节置换术,术中均采用全身麻醉和自体血回输,因年龄因素均采用生物型假体置换。结果所有患者均顺利完成手术,获得18~20个月随访,手术时间(158.6±17.5)min,术中出血量(721.2±24.4)m L,术后双侧引流量(160.0±10.5)m L,住院时间(12.5±1.0)d;术前Harris评分(48.6±3.6)分,术后Harris评分(88.6±4.5)分,术前与术后Harris评分比较差异有统计学意义(P<0.05);术前肢体不等长平均(3.7±1.1)cm,术后末次随访时肢体不等长平均(0.5±0.2)cm,术前与术后肢体长度纠正差异有统计学意义(P<0.05)。所有患者末次随访均获得良好的髋、膝关节运动功能,术后无髋关节感染、脱位、假体松动及深静脉血栓形成等并发症。结论一期双侧髋关节全髋置换治疗Crowe IV型髋关节发育不良继发骨关节炎具有可行性,临床效果满意。

Objective To evaluate the clinical significance of bilateral total hip arthroplasty(THA) in one-stage treatment of osteoarthritis secondary to Crowe Ⅳ adult developmental dysplasia of the hip(DDH). Methods The clinical data of 43 patients with osteoarthritis secondary to Crowe Ⅳ adult developmental dysplasia of the hip, who underwent one-stage bilateral THA treatment in Liuzhou People’s Hospital during January 2009 to December 2014, were retrospectively analyzed. Before the treatment, 43 patients were examined and evaluated by X-ray, CT and MRI, then treated with one-stage operation of according to the order of serious to minor. Intraoperative anesthesia and autologous blood transfusion were used in the THA operation, and the biological prosthesis replacement was employed in the THA operation due to age factors. Results All surgeries of patients were successfully performed, and follow-up time is from 18 to 20 months. The mean time of operation, blood loss, postoperative discharge, postoperative length of stay were respectively(158.6±17.5) min,(721.2±24.4) m L,(160.0±10.5) m L, and(12.5±1.0) d. The postoperative Harris hip score(88.6±4.5)was significantly higher than preoperative Harris hip score(48.6 ± 3.6), P<0.05. Compared with preoperative limb unequal length average(3.7±1.1) cm, there was a significantly increase in the average length of(0.5±0.2) cm, P<0.05. All of the cases had acquired good hip and knee function, and no patients suffered infection, dislocation, prosthesis loosening or deep vein thrombosis in our research. Conclusion The bilateral total hip arthroplasty is a feasible one-stage surgical method for osteoarthritis secondary to Crowe IV adult developmental dysplasia of the hip.