髋臼发育不良全髋关节置换术中髋臼的重建  

Reconstruction of the acetabulum in total hip arthroplasty in patient with developmental dysplasia of the hip

作　　者：赵秀祥[1] 卜延民[1] 郑得志[1] 于建华[1] 

机构地区：[1]天津医院关节外科

出　　处：《中国矫形外科杂志》2010年第15期1237-1241,共5页Orthopedic Journal of China

摘　　要：[目的]总结先天性髋臼发育不良继发骨性关节炎患者全髋关节置换术中髋臼重建的经验。[方法]2001年2月～2006年2月对45例成人髋臼发育不良继发骨性关节炎患者行全髋关节置换术,女40例,男5例,平均年龄52岁(40～63岁)。根据术前髋关节正位X线片分型,CroweⅠ型25例,CroweⅡ型10例,CroweⅢ型5例,CroweⅣ型5例。臼杯均在真臼位置生物压配固定。髋臼常规重建16例,加深髋臼至卵圆窝以内压配固定16例,,股骨头植骨8例,髋臼内壁截骨5例。于术后3、6、12个月,以后每年随访一次。摄X线片观察臼杯松动、植骨愈合情况。检查患者Trendelenburg征的变化,对髋关节功能进行Harris评分。[结果]完整随访41例,平均随访6年(3～8年)。旋转中心上移从术前(2.3±0.8)cm下降为术后(0.8±0.4)cm,P<0.05。Harris评分从术前(64±7.8)分提高到术后(93±6.2)分,P<0.05。Trendelenburg征阳性患者,从术前38例下降到术后5例。有5例X线表现臼杯松动,但无临床症状。2例植骨块明显吸收。1例因内衬破裂行翻修术。3例术后脱位,闭合复位后未再脱位。[结论]根据髋臼缺损的程度不同采用不同的重建方法,可获得臼杯的充分包容,近期疗效令人满意。[ Objective] To summarize the experience of acetabulum reconstruction of total hip arthroplasty （THA） for the patients with osteoarthritis （OA） secondary to developmental dysplasia of hip （DDH） . [ Methods] From Fehruary 2001 to February 2006 , 45 eases of total hip arthroplasty were performed in adult patients with OA secondary to DDH. Based on radiographic classification of Crowe, there were 25 cases of type Ⅰ , 10 eases of type Ⅱ , 5 cases of type Ⅲ and 5 cases of type IV. All cups were reconstructed at the true aeetabula and were eementless ones. The reconstructive methods were as follows： regular replacement for 16 hips, installing of the cup after deeply reaming the acetabulum for 16 hips, autofemoral grafting on the superior hip for 8 hips, and medialization of the cup for 5 hips. The rotation center of the hip, the unition and absorption condition of bone graft, Trendelenburg sign and Harris score were assessed preoperatively and postoperatively. [ Results] Follow - up was performed for am average of 6 years in 41 patients. At the last follow - up, the rotation center of the hip removed superiorly from preoperative （2. 3 ± 0. 8） cm to postoperative （0. 8 ± 0. 4） era, on the average （ P 〈 0.05 ） . The cases of positive Trendelenburg sign decreased from 38 to 5. Harris score improved from （64±7. 8） points to （93 ±6.2） points （P 〈0. 05） . Radiolucent lines were observed in 5 hips, but there were no clinical symptoms. Bone grafts absorption was found in 2 hips. One hip was revised because of the breakage of the liner. Three hips had dislocation. [ Conclusion] According to the severity of dysplasia, different methods could be used to reconstruct the acetabulum, good short -term effect has been observed.

关 键 词：关节成形术 髋 置换 髋脱位 先天性 随访研究 

分 类 号：R687.4[医药卫生—骨科学]