组配式假体与一体式假体修复CroweⅢ-Ⅳ型发育性髋关节发育不良的初始稳定性  

Initial stability of integrated prosthesis or combined prosthesis in the treatment of CroweⅢ-Ⅳdevelopmental dysplasia of the hip

作　　者：李扬 吕辉[1] 黄邓华 邹龙飞 张忠杰 谭美云 Li Yang;Lyu Hui;Huang Denghua;Zou Longfei;Zhang Zhongjie;Tan Meiyun(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Orthopedics,Third People's Hospital of Yibin,Yibin 644000,Sichuan Province,China)

机构地区：[1]西南医科大学附属医院骨科,四川省泸州市646000 [2]宜宾市第三人民医院骨科,四川省宜宾市644000

出　　处：《中国组织工程研究》2022年第18期2839-2843,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在全髋关节置换治疗高脱位发育性髋关节发育不良手术中,股骨颈低位截骨后使用一体式Wagner cone假体与组配式S-ROM假体的优劣目前尚不清楚。目的:探讨股骨颈低位截骨配合一体式假体或组配式假体治疗CroweⅢ-Ⅳ型发育性髋关节发育不良的优劣。方法:回顾性分析2015年9月至2019年8月西南医科大学附属医院收治的36例CroweⅢ-Ⅳ型发育性髋关节发育不良患者的临床资料,男5例,女31例,年龄27-64岁,左侧19例,右侧17例,均接受全髋关节置换治疗,其中18例股骨颈低位截骨后使用一体式Wagner cone假体,18例股骨颈低位截骨后使用组配式S-ROM假体。术后进行随访,对比两组患者髋关节功能Harris评分与目测类比评分,通过影像学检查观察两组有假体松动、下沉、双下肢长度差异、异位骨化及骨溶解、股骨近端应力遮挡等情况。结果与结论:①两组患者均获得15个月及以上的随访,术后切口均Ⅰ期愈合,未出现假体脱位、无菌性松动、假体周围感染、骨溶解及异位骨化情况;②S-ROM组股骨近端Ⅰ度应力遮挡效应15例、Ⅱ度3例,Wagner cone组骨近端Ⅰ度应力遮挡效应12例、Ⅱ度6例,组间比较差异无显著性意义(P>0.05);S-ROM组有1例患肢短缩6.7 cm患者出现股神经麻痹症状,Wagner cone组有1例患者术后出现腓静脉血栓形成;两组术后患肢短缩长度比较差异无显著性意义(P>0.05);③两组术后15个月的髋关节功能Harris评分与目测类比评分比较差异均无显著性意义(P>0.05);④结果表明,对于CroweⅢ-Ⅳ型发育性髋关节发育不良患者,股骨颈低位截骨后置入组配式S-ROM假体或一体式Wagner cone假体均可取得满意的近期疗效,但应注意S-ROM假体近端袖套的初始稳定性。BACKGROUND:In total hip replacement surgery for high dislocation developmental dysplasia of the hip,the advantages and disadvantages of using integrated Wagner cone prosthesis and combined S-ROM prosthesis after low femoral neck osteotomy are currently unclear.OBJECTIVE:To explore the advantages and disadvantages of low femoral neck osteotomy combined with integrated prosthesis or combined prosthesis in the treatment of Crowe typeⅢ-Ⅳdevelopmental dysplasia of the hip patients.METHODS:The clinical data of 36 patients with Crowe typeⅢ-Ⅳdevelopmental dysplasia of the hip in Affiliated Hospital of Southwest Medical University from September 2015 to August 2019 were analyzed retrospectively,including 5 males and 31 females,aged from 27 to 64 years.There were 19 cases on the left and 17 cases on the right.All underwent total hip replacement treatment.Among them,18 patients were treated with Wanger cone prosthesis and 18 patients with S-ROM prosthesis.During follow-up,Harris score and visual analog score of hip joint function were compared between the two groups.Through imaging examination,differences in the prosthesis loosening,subsidence,length of the lower limbs,heterotopic ossification and osteolysis,and stress shielding of the proximal femur were observed in both groups.RESULTS AND CONCLUSION:(1)All patients were followed up for 15 months and above in both groups.All incisions healed by first intention after surgery,and there was no dislocation of the prosthesis,aseptic loosening,infection around the prosthesis,osteolysis or heterotopic ossification.(2)There were 15 cases of I degree stress shielding effect in the proximal femur and 3 cases of II degree in the S-ROM group;12 cases of I degree stress shielding effect and 6 cases of II degree in the proximal femur in the Wagner cone group;no significant difference was found between the two groups(P>0.05).One patient in the S-ROM group with a shortened limb of 6.7 cm developed symptoms of femoral nerve palsy,and one patient in the Wagner cone group developed p

关 键 词：发育性髋关节发育不良 关节置换 假体 髋 股骨柄 S-ROM假体 Wanger cone假体 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]