髋关节发育不良的全髋关节置换术

Total hip replacement for congenital hip dysplasia

目的 评价全髋关节置换术治疗先天性髋关节发育不良的近、中期疗效。方法 4 8例 (6 7髋 )先天性髋关节发育不良患者行全髋关节置换术 ,随访 4 4例 6 3髋 ,平均随访时间为 5 .3年 (2～ 9年 )。按Crowe分类 ,Ⅰ型 18例 2 4髋 ,Ⅱ型 15例 2 0髋 ,Ⅲ型 6例 10髋 ,Ⅳ型 5例 9髋。手术采用后外侧切口 ,除 1例CroweⅣ型(2髋 )外 ,髋臼侧均在真臼水平重建髋臼并使用非骨水泥型假体 ,股骨侧 3例 4髋选用骨水泥型假体 ,其余均选用非骨水泥型假体。结果 2髋术后脱位经保守治疗而愈。 2髋术中小转子上方襞裂骨折 ,但股骨假体稳定。 4髋有异位骨化 ,其中BrookⅡ型 3髋 ,Ⅲ型 1髋。随访期内未发现感染、假体松动、坐骨神经损伤等并发症。髋关节功能评分 (Harris评分 )术前平均为 4 5分 ,术后平均为 89分。结论 后外侧入路、真臼水平重建髋臼是先天性髋关节发育不良全髋关节置换术安全、有效的手术技术。

Objective To evaluate the mid-term results of total hip replacement for congenital hip dysplasia. Methods A consecutive series of 67 total hip replacements was performed for congenital hip dysplasia in 48 patients. The mean age of the patients was 49 years. Sixty-three hips in 44 patients were followed up. The average follow-up of the whole series was 5.3 years. According to the Crowe rating, the degree of dislocation were stage Ⅰ in 24 hips, stage Ⅱ in 20 hips, stage Ⅲ in 10 hips, and stage Ⅳ in 9 hips. All procedures were carried out through a lateral-posterior approach. In 61 hips, the acetabular component was placed at the level of the true acetabulum. Results None of the acetabular components and the femoral stems were revised for aseptic loosening or infection during the follow-up. The Harris hip score increased in all patients after surgery from 45 preoperatively to 89 at the time of last follow-up. Conclusions The reconstruction of the hip at the level of the true acetabulum through a lateral-posterior approach is a safe and effective procedure for congenital hip dysplasia