发育性髋关节脱位全髋置换是否股骨截骨比较  

Comparison of total hip arthroplasty with or without femoral shortening osteotomy for developmental dislocation of the hip

作　　者：赵鹏[1] 窦勇[2] 王达成[2] 李玉军[2] ZHAO Peng;DOU Yong;WANG Da-cheng;LI Yu-jun(Department of Orthopedics,Yanqing Hospital,Third Hospital,Peking University,Beijing 102100,China;Department of Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京大学第三医院延庆医院骨科,北京102100 [2]北京积水潭医院矫形科,北京100035

出　　处：《中国矫形外科杂志》2021年第23期2124-2129,共6页Orthopedic Journal of China

摘　　要：[目的]比较Crowe IV型发育性髋关节脱位(developmental dislocation of the hip,DDH)行全髋关节置换术(total hip arthroplasty,THA)是否股骨短缩截骨的临床疗效。[方法]2013年3月-2018年3月,北足积水潭医院矫形科对99例Crowe IV型DDH行THA术,依据术中具体情况,32例未行股骨短缩截骨,67例行股骨粗隆下短缩截骨。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术。截骨组手术时间、术中出血量显著多于非截骨组(P<0.05),但两组切口长度、术后神经症状发生率、术后下地行走时间和住院时间的差异均无统计学意义(P>0.05)。所有患者随访1〜5年,平均随访(3.23±1.22)年。非截骨组恢复完全负重时间显著早于截骨组(P<0.05)。与术前相比,末次随访时两组患者VAS评分和双侧肢体功能性长度差异均显著减小(P<0.05),而ROM和Harris评分均显著增加(P<0.05)。末次随访时虽然两组ROM的差异无统计学意义(P>0.05),但非截骨组的Harris评分显著高于截骨组(P<0.05)。末次随访时,非截骨组患者主观满意率显著高于截骨组(P<0.05)。影像方面,与术前相比,末次随访时两组旋转中心的垂直距离和侧距均显著减小(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。[结论]对DDH行THA术是否股骨短缩截骨取决于髋关节的脱位程度,但尚无确切标准,应根据术中复位试验决定。然而,行截骨的患者临床效果不及未行截骨的患者。[Objective]To compare the clinical efficacy of total hip arthroplasty(THA)with or without femoral shortening osteotomy for Crowe type IV developmental dislocation of the hip(DDH).[Methods]From March 2013 to March 2018,99 patients underwent THA for Crowe type IV DDH in Beijing Jizhuitan Hospital.According to the concrete condition met in the operation,32 patients had no subtrochanteric femoral shortening osteotomy performed,while the remaining 67 patients had subtrochanteric shortening osteotomy conducted in THA.The patients in two groups were compared regarding to perioperative,follow-up and imaging documents.[Results]All patients in both groups had operation completed successfully.The osteotomy group consumed significantly longer operation time,associated with significantly more intraoperative blood loss than the non-osteotomy group(P<0.05),but there were no significant differences in incision length,occurrence of postoperative neurological symptoms,the time to return walking postoperatively and hospital stay between the two groups(P>0.05).All patients were followed up for 1〜5 years,with a mean follow-up of(3.23±1.22)years.The non-osteotomy group resumed full weight bearing activity significantly earlier than the osteotomy group(P<0.05).The VAS score and bilateral limb functional length differences significantly decreased(P<0.05),while the ROM and Harris score significantly increased in both groups at the latest follow-up compared with those before operation(P<0.05).Although there was no statistically significant difference in ROM between the two groups(P>0.05),the non-osteotomy group was marked significantly higher Harris score than the osteotomy group at the latest follow up(P<0.05).In addition,the non-osteotomy group proved significantly superior to the osteotomy group in term of patients'subjective satisfaction rate(P<0.05).With respect of radiographic evaluation,the vertical distance and lateral distance between the femur and the rotation center significantly reduced at the latest follow-up in both group

关 键 词：发育性髋关节脱位 全髋关节置换术 转子下短缩截骨 

分 类 号：R681.1[医药卫生—骨科学]