成人发育性髋关节发育不良人工全髋关节置换术  

Therapeutic effect of total hip arthroplasty for adult developmental dysplasia of hip

作　　者：魏宝刚[1] 吕龙[2] 

机构地区：[1]内蒙古医学院研究生院,内蒙古010017 [2]内蒙古自治区医院骨科

出　　处：《中国骨科临床与基础研究杂志》2009年第2期101-104,共4页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的探讨人工全髋关节置换术(THA)治疗成人发育性髋关节发育不良(DDH)伴骨关节炎的手术方法和疗效。方法2000年1月至2008年6月,采用THA治疗DDH伴骨关节炎45例47髋。其中CroweⅠ型8髋,Ⅱ型18髋,Ⅲ型15髋,Ⅳ型6髋。手术采用外侧入路,术中行髋周软组织松解、延长患肢以恢复真臼重建。结果所有患者均获随访,时间6个月～5年,平均26个月。术前Harris评分28～63分,平均45分;术后Harris评分82～95分,平均87分,较术前有明显提高(P<0.05)。优33髋,良10髋,可4髋,近期优良率达到91.5%。所有患者髋关节疼痛均得到缓解,活动功能满意,无假体松动及翻修病例。结论THA是治疗成人DDH伴严重骨关节炎的有效方法。术前充分准备、术中实行有效地软组织松解以及最大程度地恢复患髋的解剖形态和生理功能是重建髋臼和稳定髋臼假体的良好基础,正确选择和安放合适的假体是取得满意疗效的关键。Objective To investigate therapeutic effect of total hip arthroplasty （THA） on developmental dysplasia of hip （DDH） in adults with osteoarthritis. Method From January 2000 to June 2008, 47 PHA were performed for 45 DDH patients complicated with severe osteoarthritis. Among these cases, there were 8 coxas with Crowe I type, 18 coxas with Crowe II type, 15 coxas with Crowe III type and 6 coxas with Crowe IV type. All patients underwent lateral approach. The operation consisted of soft tissue release around coax and prolongation of the affected limb to restore real acetabulum reconstruction. Results All patients were followed up from 6 months to 60 months for average 26 months. Harris preoperative scores were 28-63 with an average score of 45, while postoperative scores were increased significantly at 82-95 with an average score of 87 （P 〈0.05）. The result was excellent in 33 coxas, good in 10 coxas, fair in 4 coxas, with a short-term improvement rate of 91.5%. Arthralgia was relieved and joint function of coxa was satisfactory, prosthetic loosening and overhauling was not observed. Conclusions THA is an effective method for adult DDH with severe osteoarthritis. To prepare sufficiently before the operation and to restore anatomic construction and physiological function of the affected limb are good bases for acetabulum re-establishment and prosthetic stabilization. Selection and implantation of suitable prosthesis are the keys to achieve satisfactory effects.

关 键 词：髋脱位 先天性 关节成形术 置换 髋 骨关节炎 髋臼 软组织松解 

分 类 号：R687.4[医药卫生—骨科学]