全髋关节置换术治疗髋臼发育不良继发骨性关节炎的临床研究

目的 探讨全髋关节置换术治疗髋臼发育不良继发骨性关节炎的手术方法 ,观察术后临床效果.方法 对16例19髋成人髋臼发育不良继发骨性关节炎进行人工全髋关节置换术,观察术后疼痛、功能活动、跛行症状的改善情况.结果 术后平均随访2年6个月,Harris评分由术前36分改善为88分,优9例,良4例,一般3例.结论 全髋关节置换术是治疗髋臼发育不良继发骨性关节炎的有效方法 .     

人工全髋关节置换术治疗髋臼发育不良近期疗效观察

目的：探讨在髋臼发育不良的病例行人工全髋关节置换术时人工髋臼安放的方法。方法：对15例22个因髋臼发育不良导致骨关节炎的病例，在行人工全髋关节置换术时，根据髋臼发育不良的程度，采用了髋臼外上缘植骨，加深髋臼及髋臼轻度内陷等三种方法。术后3、6、9、12个月及以后每半年以同等条件投照双侧髋关节正位X线片，观察人工髋臼安放的角度及人工髋臼与髋臼骨床愈合的情况。平均随访24个月。结果：随访时发现加深髋臼及髋臼轻度内陷的病例，人工髋臼与髋臼骨床接触良好，角度满意，关节功能恢复优良。而髋臼外上缘植骨的病例，术后2年时植骨块与人工髋臼之间出现了透亮带。结论：髋臼发育不良导致髋关节骨关节炎的病例在施行人工关节置换术时应根据髋臼骨床的情况采用不同的手术方式安放人工髋臼。特别是在髋臼较浅，而髋臼骨床底部骨质较多的情况下，应采用向内切磨髋臼：加深髋臼后安放人工髋臼。本组病例大部分采取此方法，收到了十分满意的临床效果。但手术中应注意不宜切磨髋臼过深，影响到髋臼内壁的稳定。     

先天性髋臼发育不良继发骨性关节炎的外科治疗

目的 探讨Zweymuller 型人工全髋关节假体置换治疗先天性髋臼发育不良继发髋关节骨性关节炎的有效性。方法 应用Zweymuller型人工全髋关节假体,对29例32个先天性髋臼发育不良继发髋关节骨性关节炎患者行全髋关节置换（THR）。患者全部为女性,单侧26例,双侧3例。Perner分型度17例,19个髋,Ⅱ度7例,7个,Ⅲ度4例,5个髋,Ⅳ度1例,1个髋。平均随访27．5个月,术前Harris评分最高59分,最低25分,平均44．5分.结果所有患者髋关节疼痛完全消失,关节活动度增加,Harris评分最高97分,最低63分,平均85分。结论 特殊设计的Zweymuller型人工全髋关节假体置换初期稳定,手术不需大块植骨和骨水泥,初期随访效果满意。     

生物型假体关节置换术治疗髋关节发育不良继发骨性关节炎

目的评估采用生物型假体行全髋关节置换术(THR)治疗髋关节发育不良(DDH)继发骨性关节炎的临床效果。方法自2001年1月～2006年3月,采用生物型假体行THR治疗44例(49髋)成人DDH继发骨性关节炎患者,根据Crowe分型:Ⅰ型10例(12髋),Ⅱ型19例(21髋),Ⅲ型11例(12髋),Ⅳ型4例(4髋)。结果随访2~8年(平均4年1个月),Harris评分由术前43.52分恢复到术后90.32分。假体均位于解剖位置,尚未见术后感染及松动发生,术前患者双下肢长度差为1~5cm,术后为0～1cm,41例46髋疼痛完全消失,3例3髋有轻度疼痛伴有轻度跛行,但能够生活自理且恢复正常工作,其余患者均步态正常。术前2例伴有腰部疼痛,均在术后1.5年消失。结论生物型假体行THR治疗成人DDH继发骨性关节炎,能够取得较好的临床效果。     

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。     

髋关节发育不良与骨性关节炎全髋置换术早期结果比较

为研究全髋置换术治疗髋关节发育不良（DDH）的疗效,作者利用新西兰关节登记中心的数据,分析比较了1 205例DDH患者和40 589例骨性关节炎患者的全髋置换术。早期随访结果显示,两组牛津髋关节功能评分和翻修率无显著差异。因此可以认为,全髋置换术治疗DDH继发关节退变是安全有效的。     

全髋关节置换术治疗重度成人髋臼发育不良并骨性关节炎的疗效分析

目的 探讨全髋关节置换术(THA)治疗成人重度髋臼发育不良(DDH)并骨性关节炎的疗效.方法 采用THA治疗DDH并骨性关节炎13例(19髋),以术前、术后Harris评分评价疗效.结果 本组平均随访23个月(13个月～4.5年).Harris评分由术前的(31.40±5.67)分增至术后的((87.64±5.83)分...     

全髋关节置换术治疗重度成人髋臼发育不良并骨性关节炎的疗效分析△

目的探讨全髋关节置换术（THA）治疗成人重度髋臼发育不良（DDH）并骨性关节炎的疗效。方法采用THA治疗DDH并骨性关协炎13例（19髋）,以术前、术后Harris评分评价疗效。结果本组平均随访23个月（13个月～4．5年）。HarTiS评分由术前的（31．40±5．67）分增至术后的（87．64±5．83）分,差异有统计学意义（P〈O．01）,随访期内未发生髋关节脱位、感染、假体松动及下沉等并发症。结论THA治疗DDH并骨性关节炎可获得满意的疗效。     

全髋关节置换治疗成人髋臼发育不良并骨性关节炎

目的探讨全髋关节置换治疗成人髋臼发育不良继发骨性关节炎的经验。方法对31例42髋成人髋臼发育不良并骨性关节炎行全髋关节置换术,其中双侧11例,单侧20例。结果术后切口均一期愈合,经过3个月～4年的随访,均能下地行走,生活自理且恢复日常工作,Harris评分从术前平均34.65分增加到术后89.26分。结论全髋关节置换术是治疗成人髋臼发育不良并骨性关节炎的有效方法,但手术难度较大,术中应充分考虑髋臼发育不良的原发及继发病理改变,以采取相应的措施。     

Chiari骨盆截骨治疗髋臼发育不良继发骨性关节炎并髋臼囊性病变

成人髋臼发育不良往往并发髋关节骨性关节炎，重者出现髋臼上方骨囊性病变，如截骨面上有较大囊变区，会影响Ｃｈｉａｒｉ骨盆截骨的效果，需采用一些特殊手段加以解决。本文总结１９９４～１９９５年资料完整的行Ｃｈｉａｒｉ骨盆截骨治疗的８例髋臼上方不同大小骨囊变区...     

强直性脊柱炎的人工全髋关节置换术(附18例/31髋中期随访分析)

目的探讨强直性脊柱炎患者行全髋关节置换术的手术方法并分析中期疗效.方法对18例(31髋)强直性脊柱炎患者行人工全髋关节置换术,并进行了平均5.2年(2～9.2年)的随访.临床随访根据Harris评分系统进行评分,X线随访根据Gruen等和Delee and Charnley分区法分别进行股骨柄和臼杯X线片分析.结果至最近1次随访,Harris评分由术前的平均27.6分(3～52分)提高到了术后的平均83.3分(54～92分)优良率为87.1%,其中,优5髋,良22髋,可3髋,差1髋.髋关节的总活动度由术前的平均35.6°(0～115°)提高到了术后的平均185.6°(54～215°).X线片未见假体松动、脱位或折断;异位骨化发生率9.7%(3髋).结论人工全髋关节置换术是强直性脊柱炎患者重建髋关节,恢复关节功能,提高生活质量的有效方法.     

全髋置换术治疗成人髋臼发育不良伴骨性关节炎

目的 探讨全髋关节置换术治疗髋臼发育不良(DDH)伴髋关节骨性关节炎的手术疗效.方法 对11例(12髋)因DDH致髋关节骨性关节炎患者行全髋关节置换术.根据Zionts分级,Ⅰ度7髋,Ⅱ度5髋.术前Harris评分28～63(48.1±9.4)分.结果 11例均获随访,时间6个月～6年.术后Harris评分为82～98(88.6±7.6)分.1例术后3年X线片示人工臼与植骨块间有透亮线,余患者人工臼位置均无移位、松动.有2例患肢轻度跛行,无疼痛,可以长距离行走.结论 全髋置换术解除患者症状,改善关节功能,提高生活质量,是一种行之有效的治疗方法.手术成功的关键在于加深髋臼、内移髋关节活动中心及适当植骨.     

全髋关节置换术治疗强直性脊柱炎髋关节强直的临床研究

目的探讨全髋关节置换术治疗强直性脊柱炎髋关节强直的手术方法及术后疗效。方法 2005年5月至2008年5月,对13例(18髋)强直性脊柱炎髋关节强直患者行全髋关节置换术,患者均为男性,平均年龄35岁(22～51岁)。术后平均随访3.8年(2～5年),根据Harris评分进行评分,根据Gruen股骨分区法和DeLee-Charnley髋臼分区法对股骨假体和髋臼假体作影像学分析。结果 13例(18髋)患者Harris评分由术前平均24.3分(0～38分)提高至术后平均87.3分(54～94分),疗效优6髋,良10髋,可2髋,优良率为88.9%。髋关节总活动度由术前平均35.4°(0°～105°)提高至术后平均192.6°(78°～225°)。X线片未见假体松动、脱位或折断,异位骨化发生率11.1%(2髋)。结论全髋关节置换术是重建强直性脊柱炎髋关节强直患者髋关节功能,提高生活质量的有效方法。     

人工全髋关节置换术治疗56例强直性脊柱炎的临床研究

[目的]探讨人工全髋关节置换术治疗强直性脊柱炎的疗效。[方法]对56例（98髋）强直性脊柱炎患者行人工全髋关节置换术，其中42例（76髋）进行了平均5．6（2．5～10．5）a的随访。[结果]至末次随访时，Harris评分由术前的平均26．8（4～51）分提高到了术后的平均85．2（55～94）分，优良率为89．5％。1例感染行Ⅱ期翻修；2例在扩髓时出现股骨颈或股骨距裂缝骨折，但未到达小粗隆以下，未予特殊处置；1例出现足下垂，术后3个月后恢复，1例深静脉血栓，余病例无假体松动、断裂以及脱位发生。异位骨化发生率9．2％（7髋），但对功能无明显影响。[结论]人工全髋关节置换术治疗强直性脊柱炎可以明显缓解髋关节疼痛，恢复关节功能，与其它病因的全髋关节置换术相比，并无较高的危险因素。     

86例(95髋)复杂人工全髋关节置换术分析

[目的]探讨复杂人工全髋置换术中髋的重建及假体置换的方法。[方法]自1995年2月-2007年6月共有86例95髋不同病因的复杂髋关节病变行全髋关节置换术，采用术前充分准备、评估、模拟，术中依具体情况，以恢复髋部的生理与正常解剖为原则，进行人工全髋置换。[结果]术后81例获得随访，随访时间6个月-10年，平均3．5年，髋关节功能按Harris评分标准，术前评分35—50分，平均42．1分，术后评分70—90分，平均82．3分。术前双下肢严重不等长2例，1例为6cm，另1例为12cm，术后下肢不等长分别为2cm、5cm。本组81例病例下肢不等长最少1cm，最多12cm，平均4cm，术后病例下肢不等长平均为1．5cm。手术切口愈合不良2例，股骨上段劈裂3例，假体脱位1例，坐骨神经损伤2例，深静脉栓塞2例。[结论]在复杂人工全髋关节置换术中，因其局部解剖结构变化大，重建与恢复髋部正常生理结构为其重点与难点，术前充分评估、模拟，术中依具体情况，最大限度地恢复髋部生理解剖，都能获得较好的临床结果。     

Follow-up study on triple-cup arthroplasty of osteoarthritis of the hip

Although various operative methods have been applied to relatively young patients with osteoarthritis of the hip, none of them has provided fully satisfactory results. Since 1974 we have been performing triple-cup arthroplasty on these patients. In this paper, the design, operative procedures and postoperative management are described, and the clinical results evaluated by the rating score system set by the Japanese Orthopaedic Association are reported. There were 67 patients consisting of 64 women and 3 men. Their ages ranged from 24 to 72 years (mean 43.5 y). The period of postoperative follow-up ranged from one year to 8.5 years (mean 4.7 y) and revealed high scores in 71% but gradual declination in 29% during five years postoperatively. The main cause of the poor results was thought to be migration of the outer cup leading to recurrence of the hip joint pain.     

全髋置换术治疗髋关节发育不良伴骨关节炎34例报告

[目的]研究全髋置换术治疗髋关节发育不良伴骨关节炎的方法及疗效。[方法]自2004年10月～2009年10月,对34例(41髋)髋关节发育不良伴骨关节炎的成年患者进行了人工全髋关节置换术,其中女性27例32髋,男性7例9髋,平均年龄5 7岁(35～76岁)。按Crowe分型,Ⅰ型16例19髋,Ⅱ型12例14髋,Ⅲ型6例8髋,术前平均Harris评分(43.5±10.5)分。[结果]手术出血量平均350 ml(200～600 ml),输血量平均230 ml(0～600ml),引流量平均200 ml(110～450 ml),手术时间平均100 min(85～130 min),术后平均Harris评分(94.5±3.2)分,较术前有明显提高(P<0.05),优良率达95%。术后平均随访4.8年(2～7年),未发现感染、无菌性松动、假体下沉、异位骨化等并发症。[结论]对于髋关节发育不良伴骨关节炎的成年患者,全髋置换术是一种较好的治疗方法。     

Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty

Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.     

Cementless total hip arthroplasty in the treatment of severe hip dysplasia or dislocated hips

We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years. In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips. Out of 19 patients, seven had bilateral dislocations. Uncemented acetabular and femoral components were used in all patients. Patients with a minimum follow-up of 1 year were included in the study. The average age at the time of surgery was 38 (range 20–69) years. Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients. In addition, subtrochanteric osteotomy was performed in four (15%) patients. A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%). A Mallory head acetabular shell was used in all cases, a 22.2-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%). The average follow-up was 3 (range 1–6) years. The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<0.05). The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<0.05). The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one. THA for DDH is a technically demanding procedure. This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH. It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals. A long-term follow-up is required in order to establish the role of this management strategy.     

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

Ankylosing spondylitis (AS) is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function. Functional impairment is significant, with spine and hip involvement, and is predominantly seen in the younger age group. Total hip arthroplasty (THA) for fused hips with stiff spines in AS results in considerable improvement of mobility and function. Spine stiffness associated with AS needs evaluation before THA. Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis. Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern. Care should be taken to reduce acetabular component anteversion at THA in these fused hips, as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation. Fused hips require femoral neck osteotomy, true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome. Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA. Risks at THA in AS include intraoperative fractures, dislocation, heterotopic ossification, among others. There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.