锥形股骨近端组配式股骨柄假体置换治疗发育性髋关节发育不良近期疗效  

SHORT-TERM EFFECTIVENESS OF TOTAL HIP ARTHROPLASTY WITH A TAPERED, MODULAR NECK HIP STEM FOR DEVELOPMENTAL DYSPLASIA OF THE HIP

作　　者：付稳[1] 徐耀增[1] 耿德春[1] 杨同其[1] 黄立新[1] 李荣群[1] 崔京福 朱世军[1] 朱锋[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国修复重建外科杂志》2014年第4期428-431,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨应用锥形股骨近端组配式股骨柄假体行人工全髋关节置换（total hip arthroplasty,THA）治疗发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的近期疗效。方法 2010年10月-2012年5月,采用锥形股骨近端组配式股骨柄假体行THA治疗28例（31髋）DDH伴继发性骨关节炎。男2例,女26例;年龄47～77岁,平均61岁。单髋25例,双髋3例。根据Crowe分型标准：Ⅰ型22髋,Ⅱ型8髋,Ⅲ型1髋。术前患者双下肢均不等长,相差（1.6±0.8）cm。髋关节活动度：屈曲（76.1±12.8）°、外展（14.5±6.7）°、内收（9.0±4.5）°、内旋（13.1±6.4）°、外旋（11.7±7.0）°。髋关节Harris评分为（44.7±11.1）分。结果 术中2例（2髋）发生股骨颈截骨面处骨裂,给予钢丝固定后愈合。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12～32个月,平均20个月。末次随访时,患者双下肢不等长相差（1.0±0.5）cm,与术前比较差异有统计学意义（t=—3.512,P=0.002）。髋关节活动度：屈曲（102.9±10.1）°、外展（32.9±6.0）°、内收（19.2±4.3）°、内旋（34.4±4.2）°、外旋（32.3±5.1）°,与术前比较差异均有统计学意义（P〈0.05）。髋关节Harris评分为（90.3±6.1）分,与术前比较差异有统计学意义（t=21.263,P=0.000）。X线片示2髋假体1年内出现进行性下沉（〈2 mm）;其余假体均无下沉、松动及断裂。髋臼假体无骨溶解或松动。2髋发生异位骨化。结论 采用锥形股骨近端组配式股骨柄假体行THA治疗DDH近期疗效满意,中远期疗效需进一步观察。Objective To analyze and summarize the short-term effectiveness of total hip arthroplasty （THA） with a tapered, modular neck hip stem for developmental dysplasia of the hip （DDH）. Methods Between October 2010 and May 2012, 28 patients （31 hips） with DDH and secondary osteoarthritis underwent THA with a tapered, modular neck hip stem. There were 2 males and 26 females, with an average age of 61 years （range, 47-77 years）. The unilateral hip was involved in 25 cases and bilateral hips in 3 cases. According to the Crowe system, 22 cases were classified as Crowe type 1, 8 as Crowe type II, and 1 as Crowe type III. At preoperation, the leg length discrepancy was （1.6 ± 0.8） cm; the hip range of motion values were （76.1 ±12.8）° in flexion, （14.5± 6.7）° in abduction, （9.0 ±4.5）° in adduction, （13.1 ± 6.4）° in internal rotation, and （11.7 ± 7.0）° in external rotation; and the Harris hip score was 44.7 ± 11.1. Results Femoral neck fracture occurred in 2 cases （2 hips） during operation, which healed by fixed with steel wire. The incisions healed by first intention. No related complication occurred. The mean follow- up time was 20 months （range, 12-32 months）. At last follow-up, the leg length discrepancy was significant decreased to （1.0±0.5） cm （t=- -3.512, P=-0.002）. The hip range of motion values were （102.9±10.1）° in flexion, （32.9 ±6.0）° in abduction, （19.2± 4.3）° in adduction, （34.4± 4.2）° in internal rotation, and （32.3±5.1）° in external rotation, all showing significant differences when compared with preoperative values （P 〈 0.05）. The Harris hip score was significantly improved to 90.3 ± 6.1 （t=-21.263, P=0.000）. The X-ray films showed no subsidence, loosening, or breakage in the other cases except 2 cases having subsidence （〈 2 mm） within 1 year. Heterotopic ossification occurred in 2 hips. Conclusion The short-term effectiveness of THA with a tapered, modular neck hip stem for DDH is satisfactory.

关 键 词：发育性髋关节发育不良 锥形股骨近端组配式股骨柄假体 人工全髋关节置换 

分 类 号：R687.4[医药卫生—骨科学]