Wangercone股骨柄联合转子下截骨治疗Crowe Ⅳ型髋关节发育不良  

Wanger cone with subtrochanteric osteotomy in the treatment of Crowe type Ⅳ developmental dysplasia of the hip

作　　者：倘艳锋[1] 李红军[1] 朱英杰[1] 蔡鸿敏[1] 贾宇东[1] 李启义[1] 刘又文[1] 

机构地区：[1]河南省洛阳正骨医院,河南省骨科医院髋部损伤科,471002

出　　处：《中国骨与关节杂志》2016年第7期503-506,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨应用Wanger cone股骨柄联合转子下截骨人工全髋关节置换术（total hip arthroplasty,THA）治疗Crowe IV型髋关节发育不良（developmental dysplasia of hip,DDH）的临床疗效。方法回顾分析2009年1月至2015年1月,我科收治的15例（17髋）成人Crowe IV型DDH患者,年龄18-49岁,平均39.4岁。左侧8例,右侧5例,双侧2例。双下肢不等长,除双侧患者外余13例患侧肢体较健侧短3.4-4.6 cm,平均3.8 cm,其中4例伴有脊柱畸形,10例Trendelenburg征阳性。X线片示患髋高位脱位。结果 15例（17髋）均采用股骨转子下横形截骨,截骨长度2.0-4.5 cm,平均3.5 cm;术后伤口均I期愈合,无脱位病例,2例出现一过性坐骨神经损伤,2个月后逐渐恢复。所有患者均获随访,随访时间13-62个月,平均42.5个月。4例股骨截骨端延迟愈合,但均在10个月内骨性愈合。下肢短缩〈1 cm者8例,下肢短缩1-2 cm者5例,下肢短缩〉2 cm者2例。本组患者术前Harris评分（33.1±4.2）分,术后12个月Harris评分（92.8±2.7）分。结论成人Crowe IV型DDH行THA治疗时,当患肢较健肢短缩〉4 cm时,通过充分松解挛缩软组织,转子下横行截骨,并结合Wanger cone生物型股骨假体,能有效避免肢体长度纠正时对神经血管的损伤以及降低复位难度,近期疗效满意。Objective To investigate the effectiveness of the subtrochanteric osteotomy with the Wanger cone in total hip arthroplasty（ THA） for Crowe type IV developmental dysplasia of the hip（ DDH） in adults. Methods From January 2009 to January 2015, 15 patients（ 17 hips） with Crowe type IV DDH were treated by THA procedures of subtrochanteric osteotomy with Wanger cone, aged 18- 49 years（ mean 39.4 years）. The left hip was involved in 8 cases, the right hip in 5 cases, and bilateral hips in 2 cases. The both limps were not of the same length. The length of the involved limp was shorter than the normal（ 3.4- 4.6 cm, mean 3.8 cm） in 13 cases, including 4 cases with spinal deformity. The results of Trendelenburg sign were positive in 10 cases. X-ray fi lms showed high complete dislocation of the involved hips. Results All patients underwent THA procedures of subtrochanteric osteotomy with Wanger cone. The length of subtrochanteric osteotomy was 2.0- 4.5 cm（ mean, 3.5 cm）. The incisions healed by the fi rst intention. There were no complications such as infection, dislocation, prosthesis loosening, or sciatic neurovascular injury. 2 cases had transient sciatic nerve symptoms in 2 months. The average follow-up was 42.5 months（ range： 13- 62 months）. Four cases were of delayed union and osseous healing was achieved in 10 months. Lower limb shortening 1 cm occurred in 8 cases, 1- 2 cm in 5 cases, and 2 cm in 2 cases. Harris score was improved from（ 33.1 ± 4.2） points preoperatively to（ 92.8 ± 2.7） points postoperatively. Conclusions Subtrochanteric osteotomy with the Wanger cone in THA for Crowe type IV DDH in adults is a good option when limp length shortening 4 cm, which is effective in decreasing the risk of neurovascular injury with satisfactory short-term results.

关 键 词：髋关节 骨疾病 发育性 截骨术 关节成形术 置换 髋 髋假体 

分 类 号：R687.4[医药卫生—骨科学]