软组织平衡在全髋关节置换术治疗成人高位髋关节发育不良中的应用  

Soft tissue balancing in the total hip arthroplasty for severe developmental dysplasia of the hip in adults

作　　者：张雷[1] 余列道[1] 杨国敬[1] 

机构地区：[1]温州医学院附属第三医院骨科,325200

出　　处：《中华外科杂志》2008年第17期1299-1302,共4页Chinese Journal of Surgery

摘　　要：目的评价软组织平衡技术在全髋关节置换术治疗成人高位髋关节发育不良的效果。方法2000年12月至2006年8月应用全髋关节置换术治疗21例（26髋）高位髋关节发育不良患者（CroweⅢ型20髋；Ⅳ型6髋）。通过软组织松解及股骨转子下短缩截骨重建髋臼于真臼水平，评价其术后临床及影像学结果。术前Harris评分平均41．2分。结果21例患者获得13个月～7年随访，平均随访时间4．8年。16例患者术后跛行程度明显改善；通过软组织松解可显著纠正下肢不等长，有效减少手术截骨长度。术后Harris评分平均89．6分。患者术后未见脱位、感染及假体松动。结论适当的软组织松解和平衡可使高位髋臼重建于真臼，有效地恢复髋关节的形态和功能，获得满意的近期效果。Objective To assess clinical result of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults. Methods From December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip. Patients were classified as type Ⅲ（ 20 hips） and type Ⅳ （6 hips） according to Crowe classification. All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy. Thereafter, postoperative clinical and radiological results were evaluated. Results The mean length of follow-up was 4. 8 years （range, 13 months-7 years）. Limp improved by at least one grade in 62% of the cases. Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0. 9 cm by effective releasing. Harris scores improved significantly from a mean of 41.2 preoperatively to 89. 6 postoperatively. No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation. Conclusion Soft tissue balancing in total hip arthropalsty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term result can be obtained by restoring normal function and anatomic structure.

关 键 词：髋脱位 先天性 关节成形术 置换 髋 松解 

分 类 号：R686[医药卫生—骨科学]