髋关节发育不良全髋置换假体轻度上移放置的中长期疗效  

Mild upward placement of acetabular implants has good mid and long-term outcome following total hip arthroplasty for developmental dysplasia of hip

作　　者：张志奇[1] 朱飞 胡舒[1] 文星钊 傅明[1] 邬培慧[1] 盛璞义[1] 廖威明[1] Zhang Zhiqi;Zhu Fei;Hu Shu;Wen Xingzhao;Fu Ming;Wu Peihui;Sheng Puyi;Liao Weiming(Department of Joint Surgery,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院关节外科

出　　处：《中华关节外科杂志（电子版）》2019年第2期145-150,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：中山大学临床研究5010计划项目(2013002)

摘　　要：目的探讨髋关节发育不良患者全髋关节置换术中髋臼假体真臼范围内以及适度上移放置对患者功能和假体长期生存率的影响。方法研究的纳入标准:髋关节发育不良继发骨关节炎,接受全髋关节置换术;使用非骨水泥型髋关节假体;手术均由同一组医生完成。排除标准:失访或随访资料不全;同期行双侧全髋关节置换术;髋关节发育不良继发骨关节炎。2008年1月至2013年12月符合入选标准的26例行全髋关节置换术的髋关节发育不良患者,其中失联及不能完成随访各1人,实际纳入随访24例,男5例,女19例;术时年龄36~80岁,平均(62±11)岁。左髋7例,右髋17例。其中Crowe I型10例、Ⅱ型8例、Ⅲ型6例。长期随访分别评估患者的Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC),并行骨盆正位、患侧股骨正侧位X线片检查评估假体情况,年龄、随访时间、评分以及手术相关指标分别采用t检验或秩和检验分析。结果本次随访时间平均(80±23)个月。至末次随访时,Harris髋关节平均评分由术前(43±13)分提高至(91±13)分(Z=-5.867,P=0.000),而WOMAC骨关节炎指数由术前(58±13)分降至(10±4)分(Z=-5.957,P=0.000)。术前患肢与对侧比较平均短缩(10±5)mm,术后患肢短缩减小至(5±4)mm(Z=-4.525,P=0.000)。末次随访患者未出现影像学上髋臼和股骨假体松动及下沉。髋臼假体上移距离为3~15mm,其中髋臼假体上移0~5 mm者8例,上移6~10 mm者7例,上移11~15 mm者9例。末次随访时,3组患者Harris评分和WOMAC评分均较术前显著改善,差异均有统计学意义(Harris:Z1=-3.366,Z2=-5.355,Z3=-3.524;WOMAC:Z1=-3.602,Z2=-3.144,Z3=-3.373;均为P<0.05);但组间比较差异无统计学意义(P>0.05)。结论髋关节发育不良患者在全髋关节置换术中髋臼假体采用放置在真臼范围内或者小于15 mm的适度上移放置,患者可获得满意的中长期疗效。Objective To investigate the mid and long-term effects of selectively upward placement of acetabular implants on post-operative function and implant survival rate of cementless total hip arthroplasty(THA)in developmental dysplasia of the hip(DDH)patients.Methods Inclusion criteria:hip dysplasia followed by osteoarthritis,total hip replacement;the use of non-cemented hip prosthesis;all surgeries were performed by the same group of doctors.Exclusion criteria:missing visit or incomplete follow-up data;bilateral total hip arthroplasty was performed simultaneously;osteoarthritis secondary to hip dysplasia.Twentyfour cases were received the final follow-up in selective 26 cases of DDH received THA between January 2008 and December 2013,including five males and 19 females with an average age of(62±11)years.The left hip was involved in seven cases and the right hip in 17 cases,including 10 cases of Crowe type I,eight cases of Crowe type II,six cases of Crowe type III.The Harris score and Western Ontario and McMaster University scores(WOMAC)were analyzed at the last follow-up compared to pre-operation.The anteroposterior X-ray films of the pelvis,anteroposterior and lateral X-ray films of the femur were performed routinely before operation and follow-up.Age,follow-up time,score and surgical indicators were analyzed by t test or rank sum test,respectively.Results The follow-up time was(80±23)months.The Harris score improved to(91±13)from(43±13)(Z=-5.867,P<0.01),and WOMAC score reduced from(58±13)to(10±4)(Z=-5.957,P<0.01).The leg length discrepancy was decreased to(5±4)mm from(10±5)mm after surgery(Z=-4.525,P<0.01).No loosening or subsidence of the implant was observed by X-ray during the follow-up.The upward distance of acetabular implant was 3~15 mm,among which eight cases were moved up 0~5 mm,seven cases were moved up 6~10 mm,and nine cases were moved up 11~15 mm.At the last follow-up,Harris scores and WOMAC scores of the three groups were significantly improved compared with those before surgery,and the differen

关 键 词：髋脱位 先天性 关节成形术 髋 假体安装 

分 类 号：R687.4[医药卫生—骨科学]