股骨转子下截骨全髋置换术治疗HartofilakidisC1和C2型髋关节发育不良的对比研究  

Comparative study of total hip arthroplasty with subtrochanteric osteotomy for treating Hartofilakidis types C1 and C2 developmental dysplasia of the hip

作　　者：褚亚明[1] 周一新[1] 寇玉辉[2] 杨德金[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035 [2]北京大学人民医院创伤骨科,北京100044

出　　处：《北京大学学报（医学版）》2015年第2期232-236,共5页Journal of Peking University:Health Sciences

摘　　要：目的:比较转子下截骨全髋置换术治疗Hartofilakidis C1和C2型成人髋关节发育不良的差异及安全性。方法:回顾性分析2007年1月至2011年12月就诊于北京积水潭医院的32例髋关节发育不良患者的临床资料,其中C1型17例,C2型15例,均行转子下截骨全髋关节置换术,术前评估和术后随访采用HSS(hospital for special surgery knee score)和WOMAC(the Western Ontario and Mc Master Universities)评分,拍摄髋关节X线片,测量双下肢不等长,记录跛行等并发症。结果:C1型HSS评分由43.7±4.6提升到87.2±7.1,WOMAC评分由43.6±4.3提升至87.5±6.7;C2型HSS评分由44.4±5.4提升到86.5±8.0,WOMAC评分由44.1±4.1提升至86.7±8.1,术后功能评分均较术前有明显改善(均P<0.001)。C2型中4例出现术中骨折,C1型中1例出现术中骨折,术后随访均愈合。术后X线片提示关节假体位置满意,无松动,股骨截骨处均愈合,无感染。结论:股骨转子下截骨全髋置换术治疗高位脱位的髋关节发育不良患者可以取得较好疗效,不同亚型(C1和C2型)在疗效上无明显差异,C2型应注意避免发生术中骨折。Objective： To compare efficacies and complications of total hip arthroplasty （ THA ） with subtrochanteric osteotomy for treating patients with Hartofilakidis types C1 and C2 developmental dyspla-sia of the hip （ DDH） .Methods：Retrospective analysis was performed in 32 patients with DDH who un-derwent THA.These patients were divided into two groups according to Hartofilakidis classification, 17 patients in type C1 and 15 in type C2.Their HSS and WOMAC scores, leg length discrepancy （LLD）, hip joint image data and complications were evaluated.Results：HSS scores in type C1 was changed from preoperative 43.7 ±4.6 to postoperative 87.2 ±7.1 （P〈0.001）, together with WOMAC scores 43.6 ± 4.3 to 87.5 ±6.7 （P〈0.001）.HSS scores in type C2 was changed from preoperative 44.4 ±5.4 to postoperative 86.5 ±8.0 （P〈0.001）, together with WOMAC scores 44.1 ±4.1 to 86.7 ±8.1 （P〈0.001）.Four cases in type C2 and one case in type C1 presented intraoperative fracture which all healed during the postoperative follow-up.The postoperative X-ray films showed that the joint prosthesis location was satisfactory, the surrounding bone was not dissolved and the bone at femur osteotomy site healed with no infection.Conclusion：For unilateral high dislocation DDH patients, THA with femur osteotomy can be effective and safe.No significant differences were found between types C1 and C2, however intraoper-ative fracture in type C2 should be paid attention to.

关 键 词：截骨术 关节成形术 置换 髋 髋脱位 先天性 

分 类 号：R684.75[医药卫生—骨科学]