人工全髋关节置换术治疗重度成人髋关节发育不良疗效分析  

EFFECTIVENESS OF TOTAL HIP ARTHROPLASTY FOR SEVERE DEVELOPMENTAL DYSPLASIA OF HIP IN ADULTS

作　　者：朱建辛[1] 王跃[1] 庞健[1] 吕波[1] 黄崇新[1] 郝鹏[1] 谭波[1] 

机构地区：[1]四川省医学科学院.四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2014年第3期335-338,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨人工全髋关节置换术（total hip arthroplasty，THA）治疗重度成人髋关节发育不良（developmental dysplasia of the hip，DDH）的疗效。 方法2007年7月－2013年1月，采用非骨水泥型THA治疗25例（27髋）重度成人DDH患者。男10例（11髋），女15例（16髋）；年龄21～57岁，平均38.6岁。左髋10例，右髋13例；双髋2例。DDH根据Crowe分型标准：Ⅲ型8例（9髋），Ⅳ型17例（18髋）。患者主要临床症状为单侧或双侧髋关节疼痛、跛行及关节活动受限。患者均存在下肢不等长，双下肢长度相差（4.9 ± 0.8）cm。Harris评分为（32.7 ± 2.9）分。 结果患者切口均Ⅰ期愈合，无感染、脱位、假体周围骨折、下肢深静脉血栓形成等并发症发生。患者均获随访，随访时间1～5年，平均3.7年。患者术前髋关节疼痛症状均消失，关节活动明显改善。末次随访时，双下肢长度相差（1.5 ± 0.3）cm，与术前比较差异有统计学意义（t=36.703，P=0.000）；其中3例遗留轻度跛行，其余患者步态均正常。Harris评分为（89.6 ± 3.2）分，与术前比较差异有统计学意义（t= —65.498，P=0.000）。X线片检查示，髋臼结构性植骨及股骨截骨端均达骨性愈合，愈合时间3～5个月，平均4.6个月。随访期间均无脱位、感染及假体松动、下沉、异位骨化等并发症发生。 结论THA治疗重度成人DDH可获得满意近期疗效，远期疗效有待进一步观察明确。Objective To evaluate the effectiveness of the total hip arthroplasty （THA） for severe development dysplasia of the hip （DDH） in adults. Methods Between July 2007 and January 2013, 25 patients （27 hips） with severe DDH underwent THA with cementless prosthesis. There were 10 males （11 hips） and 15 females （16 hips） with an average age of 38.6 years （range, 21-57 years）. The left hip was involved in 10 cases, the right hip in 13 cases, and bilateral hips in 2 cases. There were 8 cases （9 hips） of Crowe type III and 17 cases （18 hips） of Crowe type IV. The main clinical manifestations were unilateral or bilateral hip pain, claudication, and limited motion of the hip. All patients had leg discrepancy with a length difference of （4.9 ± 0.8） cm. Harris score was 32.7 ± 2.9. Results All patients obtained primary healing of incision; no infection, dislocation, periprosthetic fracture, and lower extremity deep venous thrombosis occurred. All patients were followed up 1-5 years （mean, 3.7 years）. Pain relief of the hip was obtained. The motion of the hip was improved obviously. At last follow-up, the length difference between lower limbs was （1.5 ± 0.3） cm, showing significant difference （t=36.703, P=0.000） when compared with preoperative one. Normal gait was observed in the others except 3 cases having mild claudication. Harris score was 89.6 ± 3.2, showing significant difference （t= — 65.498, P=0.000） when compared with preoperative one. The X-ray films showed bone union of the acetabular structural bone graft and femoral osteotomy ends, and the union time was 3-5 months （mean, 4.6 months）. No complication occurred as follows： dislocation, infection, prosthesis loosening or subsidence, and heterotopic ossification. Conclusion THA in the treatment of severe DDH in adults can obtain satisfactory short-term effectiveness, but long-term effectiveness needs further observation.

关 键 词：髋关节发育不良 人工全髋关节置换术 成人 

分 类 号：R687.4[医药卫生—骨科学]