Wagner Cone生物型股骨假体置换联合转子下短缩截骨术治疗成人Crowe Ⅳ型髋关节发育不良  

Total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy in treatment of Crowe Ⅳ developmental dysplasia of hip in adults

作　　者：卢玮 曾敏[1] 雷鹏飞[1] 谢杰[1] 胡懿郃[1] LU Wei;ZENG Min;LEI Pengfei;XIE Jie;HU Yihe(Department of Orthopedics,Xiangya Hospital,Central South University,Changsha Hunan,410008,P.R.China)

机构地区：[1]中南大学湘雅医院骨科

出　　处：《中国修复重建外科杂志》2019年第8期929-934,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(8167090870)~~

摘　　要：目的探讨采用Wagner Cone生物型股骨假体行人工全髋关节置换联合转子下短缩截骨术治疗成人CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)的早期疗效。方法 2015年1月-2017年6月,收治18例(20髋)CroweⅣ型DDH患者。男5例(6髋),女13例(14髋);年龄20~67岁,平均42岁。单髋16例,双髋2例。单侧患者患侧肢体较健侧缩短(4.76±2.59)cm,双侧患者双下肢等长。患髋"4"字征及Trendelenburg征均为阳性。术前Harris评分为(41.95±6.90)分,疼痛视觉模拟评分(VAS)为(5.05±1.15)分。影像学检测髋臼前倾角为(32.82±2.79)°,股骨前倾角(46.18±6.80)°,联合前倾角(79.01±7.54)°。采用Wagner Cone生物型股骨假体行人工全髋关节置换联合转子下短缩截骨术。术中截骨长度2.0~3.5 cm,平均2.38 cm。结果手术时间116~161 min,平均138.4 min;术中出血量600~1 200 mL,平均795 mL;术后引流量100~630 mL,平均252 mL。术后切口均Ⅰ期愈合。仅1例出现坐骨神经牵拉症状,对症处理后缓解。患者均获随访,随访时间12~29个月,平均18.4个月。患髋"4"字征及Trendelenburg征均为阴性。末次随访时Harris评分为(87.50±5.06)分、VAS评分为(0.75±0.85)分。术后2 d CT测量患侧髋臼前倾角为(16.21±4.84)°、股骨前倾角(18.99±2.55)°、联合前倾角(35.20±5.80)°。上述指标与术前比较差异均有统计学意义(P<0.05)。单侧患者患侧肢体长度与健侧相差(0.72±0.70)cm,与术前比较差异有统计学意义(t=7.751,P=0.000);双侧患者双下肢均等长。X线片复查示截骨面均愈合,愈合时间3~6个月,平均4.1个月;无假体周围骨折、假体松动及下沉、脱位、异位骨化、骨溶解等并发症发生。结论对于成人CroweⅣ型DDH,Wagner Cone生物型股骨假体置换联合转子下短缩截骨术可显著改善患者髋关节功能,恢复下肢长度,早期疗效较好,但需要进一步观察假体使用寿命及远期疗效。Objective To investigate the short-term effectiveness of total hip arthroplasty with Wagner Cone stem combined with subtrochanteric shortening osteotomy for adult patients with Crowe Ⅳ developmental dysplasia of the hip(DDH). Methods A clinical data of 18 patients(20 hips) with Crowe Ⅳ DDH between January 2015 and June2017 was retrospectively analyzed. There were 5 males(6 hips) and 13 females(14 hips), with an average age of 42 years(range, 20-67 years). There were 18 cases with unilateral DDH and 2 cases with bilateral DDHs. The "4" sign and Trendelenburg sign of affected hip were positive. Preoperative Harris score and visual analogue scale(VAS) score were41.95±6.90 and 5.05±1.15, respectively. The length discrepancy was(4.76±2.59) cm in patients with unilateral DDH. And the lengths of bilateral lower limbs in patients with bilateral DDH were equal. The acetabular anteversion angle, femoral anteversion angle, and combined anteversion angle were(32.82±2.79),(46.18±6.80), and(79.01±7.54)°, respectively. All patients were treated by total hip arthroplasty with Wagner Cone stem and subtrochanteric shortening osteotomy. The length of osteotomy ranged from 2.0 to 3.5 cm(mean, 2.38 cm). Results The operation time was 116-161 minutes(mean, 138.4 minutes);the volume of intraoperative blood loss was 600-1 200 mL(mean, 795 mL);the volume of drainage after operation was 100-630 mL(mean, 252 mL). All incisions healed by first intention. The symptom of sciatic nerve injury occurred in 1 case and relieved after symptomatic treatment. All patients were followed up 12-29 months(mean,18.4 months). The "4" sign and Trendelenburg sign of affected hip were negative. The Harris score and VAS score at last follow-up were 87.50±5.06 and 0.75±0.85, respectively. The acetabular anteversion angle, femoral anteversion angle,and combined anteversion angle were(16.21±4.84),(18.99±2.55), and(35.20±5.80)°, respectively. There were significant differences in above indexes between pre-and post-operation(P<0.05). The length dis

关 键 词：髋关节发育不良 Wagner Cone生物型股骨假体 转子下短缩截骨术 人工全髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]