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机构地区:[1]解放军沈阳军区总医院骨科,辽宁沈阳110016
出 处:《临床军医杂志》2014年第1期42-45,48,共5页Clinical Journal of Medical Officers
摘 要:目的探讨生物型组配式假体的全髋关节置换术联合股骨粗隆下截骨治疗CroweⅣ型髋关节发育不良(DDH)的临床价值。方法对24例(26髋)CroweⅣ型DDH患者,行生物型组配式假体(S-ROM,Depuy)的全髋关节置换术联合股骨粗隆下截骨治疗。采用Harris评分比较手术前后髋关节功能,测量术后大粗隆平移距离、肢体延长距离、髋关节旋转中心下移距离,并随访生物学固定效果。结果18例(20髋)有完整的随访资料。随访时间13~96(39.3±22.9)个月。手术前后髋关节Harris评分明显改善,差异有统计学意义(P〈0.05)。大粗隆平均平移30~65(49.1±9.5)mm,肢体延长0~13(4.9±3.4)mm,髋关节旋转中心平均下移32~63(48.0±9.2)mm。术后2例出现后脱位,2例出现下肢深静脉血栓,其余患者均无骨折、感染、有症状的下肢深静脉血栓以及血管、神经损伤等并发症发生。1例术中发生股骨矩处骨折。术后1年2例遗留轻度跛行,其余患者均无明显跛行、髋部疼痛。至随访末无假体松动、移位,无翻修病例。结论生物型组配式假体的全髋关节置换术联合粗隆下截骨治疗CroweⅣ型DDH的临床效果满意。Objective To analyze the functional and value of cementless, modular total hip arthroplasty combined with subtrochan- teric osteotomy for the treatment of patients with Crowe Group-iv developmental dysplasia of hip (DDH). Methods Twenty-four consecutive patients who had previously had Crowe Group-Ⅳ DDH (26 hips) were treated with a modular cementless prosthesis ( S-ROM, Depuy). The preoperative and postoperative Harris scores were compared. After operation, we measured the greater tro- chanter, the hip center downward mobility distance and the limb extension distance. The biological fixation effect of the prosthesis was followed up with radiographic results. Results As a result, 18 patients (20 hips) were followed up 13 - 96 (39.3 ± 22.9) months. The Harris score was improved significantly ( P 〈 0.05). The greater trochanter shifted distally to 30 - 65 (49.1± 9.5 ) mm, and the hip center to 32 - 63 (48.0 ± 9.2 ) mm postoperatively. The limb extended to 0 - 13 (4.9 ± 3.4 ) mm. Two patients had a slight limp at the time of one year after surgery, and the others had no limp and hip pain. Postoperative dislocation occurred in two hips. Two patients suffered from deep vein thrombosis, and one patient from fracture. No loosening and subsidence oc- curred. No cases were revised. Conclusion Cementless, modular total hip arthroplasty combined with subtrochanteric osteotomy for the treatment of the patients with prior Crowe Group-IV DDH results in satisfactory outcomes.
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