Crowe Ⅳ型髋关节发育不良的新分型  

New classification of Crowe type IV developmental dysplasia of the hip

作　　者：马海洋[1] 周勇刚[1] 郑充 曹文哲[1] 王森[1] 吴文明[1] 朴尚 杜银桥 

机构地区：[1]中国人民解放军总医院骨科,北京100853

出　　处：《中国骨伤》2016年第2期119-124,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：比较有继发臼和无继发臼两种病理形态的CroweⅣ型髋关节发育不良（DDH）行全髋关节置换术（THA）时是否存在实质上的不同,从而决定有无必要将CroweⅣ型DDH进一步分出亚型。方法 ：回顾性分析2007年6月至2015年5月由同一名高年资医生应用S-ROM假体对CroweⅣ型DDH行THA患者112例（145髋关节）,单侧79例,双侧33例,年龄18~68岁,分为无继发臼组和继发臼形成组。无继发臼组108髋,男12髋,女96髋,平均年龄（39.38±11.19）岁;继发臼形成组37髋,男2髋,女35髋,平均年龄（38.19±10.92）岁。术前及术后随访时均拍X线片进行观察,对临床结果采用Harris评分进行评价。比较两组在脱位高度、髓腔闪烁指数、是否需要做粗隆下截骨、髋关节Harris评分及术后并发症方面有无差异。结果：无继发臼组髋关节脱位高度为（4.74±1.57）cm,继发臼形成组（3.12±1.15）cm,无继发臼组大于继发臼形成组。无继发臼组髓腔闪烁指数为2.69±0.68,继发臼形成组3.42±0.79,继发臼形成组大于无继发臼组。无继发臼组术前Harris评分58.1±15.3,继发臼形成组58.3±16.9,两组之间差异无统计学意义;术后评分无继发臼组91.0±4.1,继发臼形成组91.0±5.1,两组之间差异无统计学意义。术后并发症：无继发臼组4髋发生股骨假体周围骨折,4髋脱位,4例出现神经症状;继发臼形成组无假体周围骨折,1髋脱位,1例出现神经症状,两组差异无统计学意义。结论：有继发臼的CroweⅣ型DDH与无继发臼者在脱位高度和股骨解剖形态方面有差异,这也决定了两者在手术方式的选择方面存在不同,因此有必要将其进一步分成无继发臼的IVA型和有继发臼的IVB型2个亚型。Objective：To compare differences between Crowe Ⅳ developmental dysplasia of the hip（DDH） with secondary acetabulum and Crowe Ⅳ DDH without secondary acetabulum,and determine whether it is necessary to divide CroweⅣ DDH into two subtypes. Methods：From June 2007 to May 2015,145 hips of 112 Crowe Ⅳ patients who underwent total hip arthroplasty（THA） using S-ROM stem were divided into two groups：secondary acetabulum formaton group（group A） and no secondary acetabulum formaton group（group B）. In group A,there were 12 females,96 males,with an average age of（39.38±11.19） years old. In group B,there were 2 females,35 males,with an average age of（38.19±10.92） years old. All the patients were evaluated by using Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up.The differences between two groups were compared on dislocation height,canal flare index（CFI）,subtrochanteric shortening osteotomy（SSTO） usage,pre and post operation Harris scores,complications. Results：The dislocation height for group A was（4.74±1.57） cm,while the dislocation height for group B was（3.12±1.15） cm. Significantly difference was detected between two groups. The CFI for group A was 2.69±0.68,while the CFI for group B was 3.42±0.79,and the significantly difference was detected between two groups. Harris scores were totally improved from 58.18±15.67 preoperatively to 91.20±3.79 post operatively and the difference was significant. Pre operative Harris scores was 58.1±15.3 in group A,58.3±16.9 in group B. Post operative Harris scores was 91.0±4.1 in group A,91.0±5.1 in group B. No significant difference was found on Harris scores between A and B preoperatively and post operatively. Complications of 4 cases peri prosthesis fracture,4 cases dislocation and 4cases nerve injury occur in group A;While only one case dislocation and one case nerve injury occur in group B. No statistical significance was detected. Conclusion：Crowe Ⅳ DDH with secondary acetab

关 键 词：髋脱位 先天性 Crowe分型 关节成形术 置换 髋 病例对照研究 

分 类 号：R681.1[医药卫生—骨科学]