髋关节发育不良的分型和植骨髋臼成形人工全髋关节置换  

Classification and treatment of development dysplasia hip in adult with auto-grafting acetabuplasty and total hip replacement

作　　者：毛宾尧[1] 胡裕桐[1] 司全明[1] 沈是铭[1] 应忠追[1] 

机构地区：[1]宁波市第一医院,宁波市骨科研究所,浙江宁波315010

出　　处：《现代实用医学》2004年第10期580-584,共5页Modern Practical Medicine

摘　　要：目的　探讨成人髋关节发育不良的分型和植骨髋臼成形的人工全髋关节置换方法和疗效。　方法　根据影像解剖学的特点 ,将 1993～ 2 0 0 4年 6月本院收治的 6 6例 (81髋 )髋关节发育不良病例分为 4型。采用自体骨植于髋臼缘 10～ 3点钟位 ,改变髋臼朝向 ,并加深髋臼、重建臼顶和后柱后壁 ,正确安置骨水泥型人工全髋假体或生物型假体。　结果　 6 6例 (81髋 )术后经平均 5年 2个月随访 ,植入骨均愈合 ;关节功能采用Harris评分 :优 (>90 ) 4 2例 5 3髋 ,良 (80～ 89) 17例 2 2髋 ,尚可 (70～ 79) 7例 7髋 ,无失败 (<70 )者 ,优良率为 89.4 %。术后有 9例出现并发症 ,均已治愈或改善。　结论　成人髋关节发育不良须进一步认识其解剖和临床特点 ,自体骨植入重建髋臼顶和后柱后壁 ,使旋转中心下移和内移 ,是人工全髋关节成功置换和提高疗效的关键。Objective To explore the classification, treatme nt methods and the effect of auto-grafting acetabuplasty and total hip replac ement on development dysplasia hip (DDH) in adult. Methods Ac cording to anatomic deformity of acetabulum on radiography, 66 cases(81 hips) of DDH in adult which treated from 1993 to June 2004 in our hospital were divided into four types.With auto-grafting acetabuplasty,the direction of acetabulum wa s changed,the acetabulums were deepen,as well as the acetabular roof, posterior column and wall were reconstructed.The position of auto-graft was ten to three o'clock of limbus of acetabulum.At last, the total hip prosthesis was placed co rrectly. Results Sixty-six cases(81 hips)were followed-up ,the mean term of follow-up was five years and two months. The hip functions w ere evaluated by Harris score: excellent(> 90) in 42 cases(53 hips), good(80～89 ) in 17 cases(22 hips), fair(70～79) in 7 cases(7 hips), no poor(< 70). The rate o f excellent and good was 89.4 percent. The auto-grafting were health cure. The complications in 9 patients were treated and most of them were recovered. Conclusion It be re-aware of anatomical and clinic charateristics on DDH in adult correctly. The keys are auto-grafting on limbus of the acetabu lum which deepened for reconstructing the acetabular roof and posterior column a nd wall. The rotational centre of hip is displaced and directed to inferior and medial. The effect of total hip replacement on the DDH would be rised.

关 键 词：髋关节发育不良 关节成形术 置换 髋 自体移植 髋臼 髋假体 

分 类 号：R691.6[医药卫生—泌尿科学]