先天性髋脱位全髋关节置换自体股骨头结构性植骨重建髋臼的应用

Femoral Head Bulk Autograft for Reconstruction of the Acetabulum of CDH in Primary Total Hip Arthroplasty

目的 :观察自体股骨头结构性植骨在先天性髋关节脱位的全髋关节初次置换中 (THR )重建髋臼缺损的临床价值。方法 :1998年 9月～ 2 0 0 1年 6月 ,对在术中应用自体股骨头结构性植骨重建髋臼的 12例先天性髋关节脱位患者 (congenitaldislocationofthehip ,CDH )作回顾性研究。其中男 5例 ,女 7例。手术时平均年龄 46岁 (3 1～ 66岁 )。根据Hartofilakidis分型 :Ⅰ型 2例 ,Ⅱ型 8例 ,Ⅲ型 2例。应用Harris评分标准及X线评价术后临床转归和植骨块愈合情况。结果 :12例患者术后平均随访 2 0个月 (7～ 2 8个月 )。术前Harris评分由 43 .6分 (3 2～ 5 7分 )增加至术后的 72 .8分 (5 5～ 96分 )。放射学显示植骨块均与骨盆愈合。 2例植骨块在髋臼假体外缘出现轻度骨吸收。髋臼假体周围无放射学透亮线存在。本组患者术后无感染发生。结论 :存在髋臼前外侧骨缺损的CDH患者 ,根据髋臼前外侧骨缺损程度选用自体股骨头结构性植骨是一种可靠而有效的方法。

Objective: To study the value of femoral head bulk autograft for reconstruction of the acetabulum of congenital dislocation of the hip(CDH) in primary total hip arthroplasty(THA).Methods:Twelve patients with CDH underwent reconstruction of acetabular defects during THA from Sep.1998 to Jun.2001 were reviewed.Five patients were male and seven female with a mean age of 46 years (31 years～66years) at the time of surgery.According to Hartofilakidis classification,CDH were classfied into type Ⅰ in 2 hips,type Ⅱ 8 hips and type Ⅲ 2 hips.Harris score system and radiograph were used for the final evaluation.Results:Twelve patients were followed up for an average period of 20 months (ranges,7 to 28 months),Harris score improved from 43.6 points pre-operation to 72.8 points at final follow-up,the incorporation of autograft bones in all patients were noticed radiographically but two hips were found absorption of the structural autograft on the outerside of the sockets.No radiolucents were found and no infection was encountered in this series.Conclusion:If acetabular deficiency on the anterolateral side in CDH is properly idendified,recontruction of the acetabulum defects with femoral head bulk autograft during primary THA is an useful and reliable method.