成人双侧Crowe Ⅳ型发育性髋关节发育不良:置换合适假体是最好的治疗策略?  

Adult bilateral Crowe type-Ⅳ developmental dysplasia of the hip: is the prosthesis an optimal therapeutic strategy?

作　　者：孙晓亮[1] 吴亮[1] 吴国锋[1] 周剑[1] 王锟[1] 张建伟[1] 周立平[1] 龚宗明[1] 唐振宇[1] 

机构地区：[1]苏州大学常州市第一人民医院骨1科,江苏省常州市213003

出　　处：《中国组织工程研究》2014年第40期6408-6412,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:CroweⅣ型发育性髋关节发育不良,表现为股骨头完全脱位,下肢明显短缩,髋臼及股骨上段发育严重不良、甚至畸形,目前尚无专门针对其治疗策略的报道。目的:探索成人双侧CroweⅣ型发育性髋关节发育不良的治疗策略。方法:收集2000年1月至2013年1月在常州市第一人民医院骨科进行治疗的12例成人双侧CroweⅣ型发育性髋关节发育不良患者,其中男5例,女7例,年龄19-47岁,平均33.5岁。骨牵引两三周后行双侧人工全髋关节置换,均于真臼位置重建髋关节旋转中心,复位困难者行转子下截骨,对于前倾角>40°的患者,行转子下旋转截骨矫正前倾角。结果与结论:治疗后所有患者髋关节疼痛消失,活动满意,步态正常,双下肢基本恢复等长,下肢延长2.5-4.8 cm,平均3.1 cm。1例患者出现坐骨神经刺激症状。患者平均随访3.5年,无骨折、脱位和假体松动等并发症出现。置换后患者Harris评分达86.3分。说明通过于真臼位置重建髋关节旋转中心、矫正前倾角、重建外展肌力、选择合适假体等,人工全髋关节置换治疗成人双侧CroweⅣ型发育性髋关节发育不良可获良好疗效。BACKGROUND：Crowe type-IV developmental dysplasia of the hip presented complete dislocation of the femoral head, significantly shortening lower limb, serious adverse development of upper segment of acetabulum and femur, and even deformity. At present, there are no reports concerning its therapeutic strategy. 〈br〉 OBJECTIVE：To explore the therapeutic strategy of adult bilateral Crowe type-IV developmental dysplasia of the hip. 〈br〉 METHODA total of 12 cases of adult bilateral Crowe type-IV developmental dysplasia of the hip, who were treated in the Department of Orthopedics, The First People’s Hospital of Changzhou from January 2000 to January 2013, were col ected. There were 5 males and 7 females, at the age of 19-47 years old, averagely 33.5 years old. After two or three weeks of skeletal traction, they received bilateral total hip arthroplasty. Hip rotation center was reconstituted at the level of the“true”acetabulum. The subtrochanteric osteotomy was performed for patients with reduction difficulty. For patients with femoral neck anteversion〉40°, subtrochanteric rotary osteotomy was performed. 〈br〉 RESULTS AND CONCLUSION：Disappearance of hip pain, satisfied move function and normal gait were gained after operation. Lower limbs recovered to be isometric. The average leg lengthening was 3.1 cm （range, 2.5 to 4.8 cm）. One patient affected sciatic nerve irritation. The average fol owed-up time was 3.5 years. No fracture, dislocation or＆amp;nbsp;loosening of the prosthesis appeared. The post-operative Harris Hip Score averaged 86.3. By reconstruction of the hip rotation center in the“true”acetabular level, correction of femoral neck anteversion, reconstruction of function of the abduction muscle and proper selection of prosthesis, total hip arthroplasty for adult bilateral Crowe type-IV developmental dysplasia of the hip could obtain good curative effects.

关 键 词：植入物 人工假体 髋脱位 髋 发育不良 关节成形 骨性关节炎 人工关节 全髋置换 HARRIS评分 

分 类 号：R318[医药卫生—生物医学工程]