应用S-ROM假体行全髋关节置换治疗Crowe Ⅳ型髋臼发育不良近期疗效观察  

Short-term outcome of total hip arthroplasty with S-ROM~ prosthesis for Crowe type Ⅳ developmental hip dysplasia

作　　者：李宝丰[1] 李凭跃[1] 沈洪园[1] 杨涛[1] 黄华扬[1] 夏虹[1] 

机构地区：[1]广州军区广州总医院骨科医院骨病关节科,广东广州510010

出　　处：《中国矫形外科杂志》2015年第9期773-778,共6页Orthopedic Journal of China

基　　金：国家自然科学基金(项目编号:81000819)

摘　　要：[目的]探讨应用S-ROM股骨柄假体行全髋关节置换术治疗Crowe IV型髋臼发育不良的方法并评价其近期疗效。[方法]2011年1月~2013年6月,应用S-ROM假体行全髋关节置换术治疗Crowe IV型髋臼发育不良患者26例38髋,其中12例双侧,14例单侧。记录术前、术后的股区视觉模拟评分（VAS）评估患者疼痛程度,记录术前肢体短缩、术中截骨及术后肢体延长长度,对临床结果采用改良Harris评分进行评价,术前行骨盆X线片及髋关节CT平扫评价髋关节发育情况及髋臼骨质情况,术后复查X线片观察假体位置、是否有骨溶解、假体松动、下沉等。[结果]26例患者均获得良好随访,随访18～48个月,平均34个月,术后3 d均可扶拐下地行走,术后未发生感染或神经损伤等严重并发症。术前、术后的股区视觉模拟评分（VAS）有显著性差异（P〈0.05）,术后股区疼痛明显减轻。术前肢体平均短缩6.5 cm,术中平均截骨2.5 cm,术后延长4.0 cm。改良Harris评分由术前平均（43.2±7.4）分改善至术后（84.8±8.1）分。X线片观察显示臼杯在真臼位置,金属臼杯、股骨柄假体位置良好,无明显松动,无假体松动或位置不当需要翻修的病例。所有实行臼侧植骨和股骨截骨的患者植骨及截骨处术后6个月已骨性愈合。[结论]对Crowe IV型髋臼发育不良患者行全髋关节置换术时,将臼杯安放在真臼位置、粗隆下截骨短缩股骨及使用S-ROM组配式股骨柄假体能提高全髋关节置换术的近期疗效,远期疗效尚待进一步观察。[Objective] To evaluate the efficacy of total hip arthroplasty with the S- ROM femoral stem prosthesis（ De Puy Synthes,Warsaw,IN,USA） in treatment of Crowe type IV developmental hip dysplasia. [Methods] Twenty- six patients with Crowe type IV developmental hip dysplasia were treated by total hip arthroplasty with S- ROM prosthesis,combined with subtrochanteric osteotomy,from January 2011 to June 2013,with 12 cases being bilateral and 14 unilateral for a total of 38 hips treated. Pain in the femoral region was evaluated with a visual analog scale（ VAS） before and after the operation. Preoperative limb shortening,osteotomy length,and postoperative limb lengthening were recorded. Hip joint function was evaluated according to the Harris hip score. A radiograph and CT scan of the pelvis were obtained before the operation to evaluate the hip and acetabular bone. Postoperatively,radiography was used to determine prosthesis position and check for complications.[Results] Patients were followed up for an average of 34 months（ range 18 to 48）. No infection,prosthesis loosening,or symptomatic deep venous thrombosis occurred. VAS score in the femoral region improved significantly after the operation（ P〈0. 05）. Mean preoperative limb shortening,osteotomy length,and postoperative limb lengthening were 6. 5 cm,2. 5 cm,and4. 0 cm,respectively. Harris score improved from（ 43. 2 ± 7. 4） preoperatively to（ 84. 8 ± 8. 1） postoperatively. Radiographs showed that the femoral stem prosthesis was in good position,with the metal acetabular cup located in the true acetabulum. No loosening,subsidence,screw breakage,or osteolysis occurred. Six months after the operation,bone union was observed at the osteotomy site on the side of the femur. [Conclusion] Total hip arthroplasty using the S- ROM prosthesis,combined with subtrochanteric osteotomy,appears to be effective for Crowe type IV developmental hip dysplasia. However,further follow- up is required to confirm long- term efficacy.

关 键 词：髋臼发育不良 S-Rom股骨柄假体 全髋关节置换 粗隆下截骨 

分 类 号：R687.4[医药卫生—骨科学]