人工全髋关节置换治疗成人髋关节发育不良  

Total hip arthroplasty in the treatment for adult developmental dysplasia of hip

作　　者：李苏皖[1] 陆斌[1] 谢洋[1] 付国建[1] 陈小强[1] 胡旺阳[1] 

机构地区：[1]马鞍山市人民医院关节外科,安徽马鞍山243000

出　　处：《临床骨科杂志》2016年第1期38-41,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨成人髋关节发育不良（DDH）行人工全髋关节置换（THA）的手术方法及早期疗效。方法对21例成人DDH继发骨关节炎患者（22髋）行生物型THA。髋关节脱位按Crowe分型：Ⅰ型15髋,Ⅱ型和Ⅲ型共6髋,Ⅳ型1髋。髋臼重建方式中采用真臼加深内移15髋,结构性植骨4髋,旋转中心上移3髋。1髋CroweⅣ型行转子下短缩截骨。结果患者均获得随访,时间6~24个月。无假体周围感染、假体不稳及松动。X线片显示结构性植骨无塌陷,转子下截骨部位愈合良好。髋关节功能Harris评分：术前30~53（38.6±5.6）分,术后76~94（84.2±6.8）分。结论 THA治疗成人DDH早期疗效满意,与普通THA相比,DDH的THA技术要求高,操作较复杂。Objective To evaluate the operation method of total hip arthoplasty（ THA） and early results in treatment for adult developmental dysplasia of hip（ DDH）. Methods 21 patients with osteoarthritis secondary to DDH（ 22hips） were treated with cementless THA. According to the classification of Crowe type,15 hips were classified as type Ⅰ,6 type Ⅱ and Ⅲ,1 type Ⅳ. The methods of acetabular reconstruction include medialization of cup in 15 hips,bulk femoral head autograft from the resected femoral head in 4 hips and high hip center in 3 hips. One case of Crowe Ⅳ was treated with femoral shortening subtrochanteric osteotomy. Results During the period of follow-up ranging from 6 months to 24 months,periprosthetic infection,prosthesis instability and prosthesis loosening were not found in all cases. X-ray showed no collapsed grafts in the patients with bulk femoral head autograft and good bone union in femoral shortening subtrochanteric osteotomy. Harris score was used to evaluate the function of hip with scores of 30 ~ 53（ 38. 6 ± 5. 6） preoperation and 76 ~ 94（ 84. 2 ± 6. 8） in the postoperation. Conclusions THA is an effective treatment with satisfactory early outcomes for adult DDH. Compared with conventional THA,the surgical technique for DDH is high-demanding and more complex.

关 键 词：髋关节发育不良 人工全髋关节置换 髋臼重建 

分 类 号：R681.1[医药卫生—骨科学] R687.4[医药卫生—外科学]