全髋关节置换术治疗成人髋关节发育不良的髋臼重建

目的探讨全髋关节置换术治疗成人髋关节发育不良（DDH）时不同方式髋臼重建对疗效的影响。方法 2000年1月至2007年10月,36例（44髋）先天性髋臼发育不良患者进行了全髋关节置换。年龄42～65岁,平均48岁。术前Harris评分平均为49.9分,双下肢长度差异平均为1.8 cm,髋关节平均活动度：屈曲59.6°,外展21.6°,内收13.9°,外旋10°,内旋8.2°。术中臼杯均安装于真臼处,髋臼内移14髋,髋臼内陷成形术18髋,自体股骨头结构性植骨12髋。髋臼侧均选用非骨水泥型假体。疗效评价：根据Harris评分分为优、良、可、差四级。结果所有患者均获得随访,随访时间1.8～9.2年,平均5.1年。平均Harris评分由术前的49.9分恢复到术后的90.1分,两者比较有统计学差异（P〈0.01,t=28.807）,其中评定为优23髋、良17髋、可4髋,术后优良率达90.9%。术后髋关节平均活动度：屈曲105°,外展35°,内收15.8°,外旋45°,内旋15°。本组病例无肺栓塞、深静脉血栓形成、感染等并发症发生。X线检查示假体无松动移位,无翻修病例。结论全髋关节置换术治疗成人髋臼发育不良采用恰当的髋臼重建结合非骨水泥型髋臼假体可获得满意中远期疗效。

Acetabular reconstruction of total hip arthroplasty for development dysplasia hip

Objective To explore the effects of various reconstruction of acetabulum in treatment of development dysplasia hip（DDH） with total hip arthroplasties（THA）.Methods Thirty-six cases（44 hips） with development dysplasia hip were treated with THA between Jan.2000 and Oct.2007.The age of the patients at surgery ranged from 42～65 years（mean,48 years）.The preoperative average length difference between two legs was 1.8 cm.The average range of motion of the hip：flexion 59.6°,abduction 21.6°,adduction 13.9°,external rotation 10°,internal rotation 8.2°.The acetabular reconstruction was done at the true acetabular location with cementless acetabular component in all hips,including acetabulum ingression for 14 hips,controlled acetabulum central fracture for 18 hips and autogenous bulk femoral head graft for 12 hips.The effects of the treatment and the clinical outcomes were graded into excellent,good,fair and poor evaluated according to Harris hip score system（HHS）.Results All hips were followed up from 1.8-9.2 years （mean 5.1 years）.Postoperative HHS averaged 90.1 points,significantly improved from the preoperative 49.9 points（t =28.807,P0.01）.The hip function were excellent in 23 hips,good in 17 hips,fair in 4 hips and the post-operative good-to-excellent rate was 90.9%.The average range of motion of the hip postoperatively;flexion 105°,abduction 35°,adduction 15.8°,external rotation 45°,internal rotation 15°.There were no noticable complications found postoperatively.The femoral head autografts were not absorbed and neither loosening nor dislocation of the acetabular prostheses occurred in the time of follow-up.Conclusion Cementless acetabular component in THA for treatment of development dysplasia hip followed suitable acetabular reconstruction can achieve satisfactory middle and long term results.