肢体延长后行全髋关节置换治疗CroweⅣ型髋关节发育不良  

Treatment of Crowe type IV developmental dysplasia of the hip with total hip arthroplasty after lirnb-lengthing with external fixator

作　　者：曹发奇[1] 杨述华[1] 许伟华[1] 叶树楠[1] 刘先哲[1] 冯勇[1] 张波[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华骨科杂志》2013年第10期1012-1017,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨骨外固定延长器肢体延长后采用全髋关节置换（total hip arthroplasty，THA）治疗年轻CroweIV型发育性髋关节发育不良（developmental dysplasia of the hip，DDH）继发骨关节炎的方法与疗效。方法回顾性分析2007年10月至2012年1月，治疗12例单侧CroweIV型DDH继发骨关节炎患者资料，男2例，女10例；年龄18-35岁，平均25．7岁。采取分次手术的方法，初次手术行软组织松解及安装髂股外固定延长器，术后每天延长3-5mm，待纠正肢体短缩，即股骨头下移至真臼水平后再行THA。THA术中采用生物型假体结合自体股骨头移植重建髋臼。所有手术均无需短缩股骨。结果初次手术时间（35．2＋3．6）min，术后住院时间（13_3±1．6）d。再次手术时间（77．3_＋12-4）min，术后住院时间（9．2±2．5）d。12例患者均获得随访，随访时间9＂＇48个月，平均（13．6--．3．2）个月，肢体不等长由术前（5．6±1．5）cm恢复到术后（0．5±0．2）cm；Harris评分由术前（45．7±2．6）分提高到术后（92．3±3．3）分。12例患者末次随访均获得良好的髋、膝关节功能。术后无一例出现钉道感染、牵引针无菌性松动、髋关节感染、假体松动脱位及深静脉血栓形成等并发症。3例在肢体延长过程中出现小腿-过性神经麻痹，经调整牵引速度后缓解，5例在THA术后出现小腿皮肤麻木，均未行治疗而在术后6周缓解。结论针对年轻的CroweIV型DDH继发骨关节炎患者，可先通过髂股牵引恢复肢体长度，而后再行THA。这种逐步延长的方式既可避免神经损伤，又可显著改善患肢功能，并发症少。Objective To retrospectively analyze the methods and clinical outcome to treat Crowe type IV developmental dysplasia of the hip （DDH） in young adults with total hip arthroplasty （THA） after limb-lengthing with external fixator. Methods From October 2007 to January 2012, 12 patients with unilateral Crowe type IV DDH were treated with two-staged surgical method in our department. There were 2 males and 10 females with an average age of 25.7 years （range, 18-35 years）. In the first stage, the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for 10-17 days. There were 1-2 cm distraction at the first time and 3-5 mm daily distraction. When the femoral head was distracted to the level of anatomical position, the second stage-THA was performed. All patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction. The acetabular cup was placed in the anatomical position in every patient. Shorten- ing femoral osteotomies were not required. Results The mean time of first operation was 35.2±3.6 min, and hospital stay was 13.3＋1.6 days. The mean time of second operation was 77.3±12.4 rain, and hospital stay was 9.2±2.5 days. The average follow-up was 13.6±3.2 months, limb-length discrepancy was 5.6±1.5 cm on average preoperatively and 0.5±0.2 cm on average postopera- tively. The Harris hip score was increased from 45.7±2.6 preoperatively to 92.3-＋3.3 postoperatively. All of the cases had acquired good hip and knee function. No patient suffered pin-site infection, hip joint infection, prosthesis loosening or deep vein thrombo- sis in our research. Transient nerve palsy occurred during the leg limb lengthening in 3 cases; calf skin numbness after THA oc- curred in 5 cases. Conclusion For the Crowe type IV DDH in young adults, normal limb length can be restored nearly and avoid nerve injury via continuously limb-lengthing with external fixator before THA. This method can get precise results, improve limb function s

关 键 词：关节成形术 置换 髋 骨疾病 发育性 骨延长术 

分 类 号：R687.4[医药卫生—骨科学]