全髋关节置换术治疗脊髓灰质炎后遗症患者非瘫痪侧髋关节发育不良的效果观察  

Observation of the effect of total hip arthroplasty on the treatment of nonparalytic hip dysplasia in patients with residual poliomyelitis

作　　者：梅晓亮 郭亭 丁浩 包倪荣 王北岳 周利武 张雷 赵建宁 Mei Xiaoliang;Guo Ting;Ding Hao;Bao Nirong;Wang Beiyue;Zhou Liwu;Zhang Lei;Zhao Jianning(Department of Orthopedic,the Affiliated Taizhou People's Hospital of Nantong University,Taizhou 225300,China;Department of Orthopaedics,General Hospital of Eastern Theater Command of PLA,Jinling Clinical College of Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南通大学附属泰州市人民医院骨科,江苏省泰州市225300 [2]南京医科大学金陵临床医学院,解放军东部战区总医院骨科,南京210002

出　　处：《中华解剖与临床杂志》2020年第2期141-145,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81702170、81572111、81772318);江苏省自然科学基金(BK20170624)。

摘　　要：目的探讨全髋关节置换术(THA)治疗脊髓灰质炎后遗症患者非瘫痪侧髋关节发育不良(DDH)的临床效果。方法回顾性分析2015年1月—2018年4月解放军东部战区总医院骨科收治的12例非瘫痪侧因DDH行THA的脊髓灰质炎后遗症患者的临床资料。其中男5例,女7例;年龄35~52岁,平均40.2岁;CroweⅠ型6髋,CroweⅡ型5髋,CroweⅢ型1髋。患者均采用后外侧入路治疗。观察患者手术时间、术后住院时间、出血量及并发症;对比手术前后患者Harris髋关节评分和疼痛VAS变化,采用Harris髋关节评分评定疗效。结果本组12例患者均顺利完成手术。手术时间51~91(64.9±11.0)min;术中出血量203~347(282.7±44.4)mL,术后急性失血量353~485(414.2±51.6)mL;术后住院时间4~9 d。术后无感染、骨折、神经血管损伤等并发症发生,手术切口均获得一期愈合。术后患者均获随访6~24个月,平均18个月。随访期间,患者下地行走良好,无假体脱位及假体松动发生。末次随访髋关节Harris评分较术前明显增加,分别为(62.8±7.52)和(90.2±2.64)分;末次随访VAS较术前明显降低,分别为0.00(0.00,0.00)分和4.00(3.00,6.00)分,差异均有统计学意义(t=11.913、Z=10.864,P值均<0.05)。术后髋关节Harris评分评定:优10髋,良2髋。结论通过对髋关节假体安放位置进行合理设计,采用THA治疗脊髓灰质炎后遗症患者非瘫痪侧DDH可以取得满意的疗效。Objective To investigate and observe the clinical outcomes of the patients with residual poliomyelitis who underwent total hip arthroplasty(THA)on their nonparalytic limbs.Methods The clinical data of 12 patients with poliomyelitis sequelae who needed total hip replacement due to developmental dysplasia of hip(DDH)admitted to the Department of Orthopedics,General Hospital of Eastern Theater Command from January 2015 to April 2018 were retrospectively analyzed.All the 12 patients were performed on the nonparalytic limbs.There were 5 males and 7 females,mean age was 40.2(35-52)years old.Hip dysplasia Crowe classification:CroweⅠtype 6 hips,CroweⅡtype 5 hips,CroweⅢtype 1 hip.Total hip arthroplasty was performed with a posterolateral approach.To observe the postoperative hospital stay,bleeding and postoperative complications.Harris hip score and VAS score before and after surgery were compared,and the efficacy was evaluated by Harris hip score.Results All the 12 patients in this group were operated successfully.The operation time was 51-91(64.9±11.0)min.Intraoperative blood loss were 203-347(282.7±44.4)mL,and postoperative acute blood loss were 353-485(414.2±51.6)mL.Postoperative hospital stay were 4-9 days.Postoperative complications such as infection,fracture and neurovascular injury was not found.All the 12 patients were followed up for 6-24 months,an average of 18 months.During the follow-up,the patients walked well without dislocation or loosening of the prosthesis.At the last follow-up,compared with preoperative,the Harris hip score were significantly increased(62.8±7.52 and 90.2±2.64,respectively)and the VAS was significantly decreased[0.00(0.00,0.00)and 4.00(3.00,6.00)],respectively,with statistically significant differences(t=11.913,Z=10.864,all P values<0.05).Harris score was used to evaluate the clinical efficacy:excellent 10 hips,good 2 hips.Conclusions By properly designing the placement of hip prosthesis,total hip replacement can achieve favorable results in the treatment of non-paralyzed hip

关 键 词：关节置换术 置换 髋 髋关节发育不良 脊髓灰质炎后综合征 

分 类 号：R687.4[医药卫生—骨科学]