旋转中心内移结合上移重建髋臼技术治疗Crowe Ⅱ、Ⅲ型成人发育性髋关节发育不良的疗效分析  

Efficacy of total hip arthroplasty in the treatment of Crowe Ⅱ and Ⅲ developmental dysplasia of hip in adults

作　　者：朱贤平[1] 滕晓[1] 泮宸帅 王湖兵 王勇[1] 

机构地区：[1]台州市中心医院(台州学院附属医院)骨科,浙江台州318000

出　　处：《中华危重症医学杂志（电子版）》2017年第1期34-39,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

摘　　要：目的探讨应用旋转中心内移结合上移重建髋臼技术在人工全髋关节置换术(THA)治疗CroweⅡ、Ⅲ型成人发育性髋关节发育不良(DDH)的疗效。方法选取台州市中心医院2006年4月至2014年7月接受THA治疗的DDH患者48例(58髋),按Crowe分型分为三组。研究组包括CroweⅡ型组14例(19髋)和CroweⅢ型组11例(14髋),均应用旋转中心内移结合上移重建髋臼技术;选取同期的CroweⅠ型患者23例(25髋)作为对照组,CroweⅠ型患者均使用解剖位重建髋臼技术。术后3个月、6个月及24个月通过影像学检查和Harris评分等评价患者术后功能。结果术后CroweⅠ、Ⅱ、Ⅲ型组患者臼杯旋转中心距泪滴连线的垂直距离[(18.3±2.5)mm、(25.4±3.2)mm、(29.6±4.8)mm]、水平距离[(27±5)mm、(21±4)mm、(21±4)mm]的比较,差异均有统计学意义(F=10.992、11.271,P均<0.05)。而三组间CE角的比较,差异无统计学意义[(16°±4°)、(17°±4°)、(16°±5°),F=0.355,P>0.05]。CroweⅠ型组与CroweⅡ、Ⅲ型组术前Harris评分的比较,差异有统计学意义[(51±15)分vs.(43±17)分,(51±15)分vs.(39±16)分,P均<0.05];而三组间术后3个月[(88±10)分、(86±12)分、(86±13)分]、6个月[(89±9)分、(88±10)分、(85±13)分]及24个月[(88±9)分、(88±10)分、(86±10)分]随访的Harris评分比较,差异均无统计学意义(P均>0.05)。随访末期所有患者Trendelanburg征阴性,步态良好,无跛行。结论 CroweⅡ、Ⅲ型成人DDH患者在THA中应用旋转中心内移结合上移重建髋臼技术是一种有效的方法,临床疗效及影像学结果满意。Objective To investigate the short-term efficacy of total hip arthroplasty（THA） in the treatment of CroweⅡand Ⅲ developmental dysplasia of hip（DDH） in adults after displacing the hip center of rotation on inner and upper side. Methods Forty-eight DDH patients（58 hips） with THA treatment in Taizhou Central Hospital from April 2006 to July 2014 were enrolled and divided into the three groups based on Crowe types. The research groups including the CroweⅡgroup [n = 14 cases（19 hips）] and the Crowe Ⅲ group [n = 11（14 hips）],were treated with the technique of displacing the hip center of rotation on inner and upper side during THA. The control group was the CroweⅠgroup [n = 23（25 hips）], and was treated with the technique of anatomical reconstruction of acetabulum. The X-ray films on post-anterior position were rechecked on 3 days, 3 months, 6 months and 24 months after THA surgery. We evaluated the post-operation function with imaging examination and Harris score. Results The comparison of the mean vertical distance [（18.3 ± 2.5） mm,（25.4 ± 3.2） mm,（29.6 ± 4.8） mm] and horizontal distance [（27 ± 5） mm,（21 ± 4） mm,（21 ± 4） mm] between rotation center and interteardrop line in the CroweⅠ, ⅡandⅢgroups after surgery were significantly different（F = 10.992,11.271; all P〈0.05）. There were no statistical differences of CE angles in the Crowe Ⅰ, Ⅱ,Ⅲgroups [（16° ± 4°）,（17° ± 4°）,（16°± 5°）; F = 0.355, P〈0.05]. The mean Harris scores between CroweⅠgroups and CroweⅡ, Ⅲ groups before surgery were significantly different [（51 ± 15） vs.（43 ± 17）,（51 ± 15） vs.（39 ± 16）; all P〈0.05]. On 3 months [（88 ± 10）,（86 ± 12）,（86 ± 13）], 6months [（89 ± 9）,（88 ± 10）,（85 ± 13）] and 24 months [（88 ± 9）,（88 ± 10）,（86 ± 10）] after surgery,the mean Harris scores among the three groups have no significant differences（all P〈0.05）. All patients had excellent gait without l

关 键 词：发育性髋关节发育不良 人工全髋关节置换 Crowe分型 

分 类 号：R687.4[医药卫生—骨科学]