髋关节发育不良患者全髋关节置换术的髋臼中心化

目的 探讨采用全髋关节置换术(THA)治疗髋关节发育不良继发骨关节炎术中髋臼杯假体放置的方法及其对手术疗效的影响。方法 对38例(44髋)于1989年9月至2003年4月接受全髋人工关节置换术的髋关节发育不良继发骨关节炎患者进行了随访。其中男14例,女24例,平均年龄51．2岁(29～80岁),平均随访36．4个月(8～168个月)。按Crowe方法进行分类：Ⅰ型12髋,Ⅱ型24髋,Ⅲ型7髋,Ⅳ型1髋。测量泪滴与髋旋转中心的水平距离并与术后测量结果比较。结果 髋臼杯假体中心化放置者24髋,未加深髋臼者20髋。术后两组Harris评分分别为90．2分、86．3分。结论 对于多数髋关节发育不良患者在行THA时,术中加深髋臼而将髋旋转中心内移和下移,可使髋臼杯假体置于中心化位置得到牢固固定及满意的骨覆盖,术后获得良好的临床疗效。

Acetabular component centralization in total hip arthroplasty for acetabular dysplasia

OBJECTIVE: To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis. METHODS: A retrospective review was undertaken of 44 hips (38 patients) that had had a total hip arthroplasty for acetabular dysplasia with secondary osteoarthritis from September.1989 to April. 2003. 14 were male (one bilateral) and 24 patients were female (5 bilateral). The mean duration of clinical and roentgenographic follow-up was thirty-six months (range, eight to one hundred and sixty-eight months), and the mean age of the patients was fifty-one years (range, twenty-nine to eighty years). Twelve hips were classified as type I; twenty-four as type II; seven as type III; and one as type IV, according to the criteria of Crowe. The horizontal location of the center of the hip (the distance along the interior drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head) was measured. RESULTS: There were 24 acetabular components that were placed in the centralized position and the other 20 in no deepen placement post-operatively. At the most recent follow-up, the mean Harris hip score was 90.2, 86.3 for the centralized position and the undeepen placement hips respectively, there was a significant difference between these two groups. CONCLUSIONS: In order to obtain the stability of acetabular component, deepen acetabular reaming is necessary for the most acetabular dysplasia in THA. In this way the anatomical rotational center can be obtained medially and lowly. The excellent long-term function will be maintained.