自体股骨头旋转植骨重建髋臼治疗髋关节发育不良的中期疗效  

Midterm outcomes of the rotational femoral head autografting in total hip arthroplasty for developmental dysplasia of the hip

作　　者：陈恺哲 冯建民[1] 何川[1,2] 刘志宏[1,2] 王毅[1,2] 杨庆铭[1,2] CHEN Kai-zhe;FENG Jian-min;HE Chuan;LIU Zhi-hong;WANG Yi;YANG Qing-ming(Department of Orthopaedics,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai Institute of Traumatology and Orthopaedics,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,上海200025 [2]上海市伤骨科研究所

出　　处：《骨科》2018年第5期354-358,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(81071473);上海市卫生和计划生育委员会课题(201540275)

摘　　要：目的评估自体股骨头旋转植骨填充技术重建髋臼治疗发育性髋关节发育不良(developmental dysplasia of the hip, DDH)的中期疗效。方法回顾性分析2012年3月至2016年12月,16例(16髋)采用全髋关节置换术(total hip arthroplasty, THA)合并自体股骨头旋转植骨技术治疗的DDH病人,女13例,男3例;手术时病人年龄为37~72岁,平均51.0岁;CroweⅢ型DDH 14例,Ⅳ型2例;均为单侧手术,其中左侧10例,右侧6例。所有髋关节置换假体均为非骨水泥型。收集记录其术前、术后的Harris评分及各种并发症;通过双侧髋关节正位(或骨盆正位)、患侧髋关节侧位X线片,以判断人工假体位置及植骨愈合情况。结果本组16例病人的随访时间为18.0~74.4个月,平均40.8个月。术前Harris评分为28~58分,平均为41.8分;所有病人末次随访时均无需辅助行走,术后末次随访时的Harris评分为84~96分,平均为89.6分。所有病例末次随访时均显示植骨块愈合迹象,假体位置良好,无移位或周围透亮线出现,也无螺钉断裂情况出现。1例病人外伤后同侧耻骨支、坐骨支骨折,予以保守治疗后痊愈,髋关节功能良好。结论应用自体股骨头旋转植骨填充技术对DDH病人行髋臼侧重建,疗效满意,植骨愈合率高,能为将来可能的髋关节翻修提供更多的骨量储备。Objective To evaluate the mid-term efficacy and feasibility of reconstruction of the acetabulum with autologous femoral head rotational grafting in total hip arthroplasty （THA） for developmental dysplasia of the hip （DDH）. Methods Sixteen patients （16 hips） with DDH who underwent THA combined with autologous femoral head rotational grafting from March 2012 to December 2016 were retrospective analyzed, including 13 females and 3 males. The average age at the operation was 51.0 years （range of 37-72 years old）. There were 14 cases of Crowe Ⅲ DDH, and 2 cases of type Ⅳ. All of them were given unilateral surgery, including 10 cases on the left side and 6 cases on the right side, respectively. Cementless prostheses were used in all arthroplasties. Clinical follow-up included preoperative and postoperative Harris scores and various complications; imaging evaluation included bilateral hip orthotopic （or pelvic orthotopic） and ipsilateral hip lateral radiographs to determine the position of the implants and the bone graft healing. Results The 16 patients in our research were followed up for 18.0-74.4 months with an average of 40.8 months. The average Harris score was 41.8 （range, 28-58） preoperatively, and 89.6 （range, 84-96） at the latest follow-up. All patients did not need to assist walking at the last follow-up. The satisfactory radiologic signs of bone graft healing and position of the prosthesis were observed in all cases at the last follow-up. None of the cases showed displacement or peripheral radiolucent lines, and no screw fracture occurred as well. One patient had a traumatic ipsilateral pubic and sciatic fracture, whose hip function was achieved after conservative treatment. Conclusion The rotational femoral head autograft technique for acetabular reconstruction with DDH has satisfactory clinical and radiographic outcomes in mid-term follow-up. The high rate of autograft incorporation with the technique means it would provide beneficial bone stock for any possible future revisi

关 键 词：髋脱位 先天性 关节成形术 置换 髋 股骨头 旋转 骨移植 

分 类 号：R687.4[医药卫生—骨科学]