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。     

全髋关节置换术治疗髋臼发育不良

目的探讨全髋关节置换术治疗因髋臼发育不良(developmentaldysplasiaofthehip,DDH)致髋关节骨性关节炎的手术方法。方法1986年2月～2004年11月,对24例因DDH致髋关节骨性关节炎患者行全髋关节置换术。其中男4例,女20例。年龄33～59岁,平均47岁。双侧8例,单侧16例。主要症状为疼痛及跛行。根据Hartofilakidis分类方法,半脱位2髋,低位脱位21髋,高位脱位9髋,术前Harris评分分别为56.70±2.75、36.09±4.16及29.45±2.16分。结果术后均获随访6个月～8年,平均3年4个月。半脱位、低位脱位及高位脱位患者术后Harris评分分别为93.10±2.10、92.73±3.20及88.09±3.67分,与术前比较差异均有统计学意义(P<0.01)。术后6侧下肢轻度跛行,均无疼痛,可以长距离行走。X线片示人工髋关节位置佳,无明显松动及下沉。结论加深髋臼、内移髋关节活动中心及改进植骨方法,是增加人工臼稳定性手术成功的关键。     

髋关节发育不良人工全髋关节置换术中髋臼中心重建

目的探讨髋关节发育不良(developmental dysplasia of hip,DDH)的人工全髋关节置换(total hiparthroplasty,THA)术中髋臼中心重建方法及疗效。方法 2004年1月-2010年1月,对29例(32髋)DDH患者行THA。男6例(6髋),女23例(26髋);年龄45～67岁,平均50.6岁。左侧22髋,右侧10髋。DDH按照Crowe分型标准:Ⅰ型12髋,Ⅱ型20髋。患者双下肢不等长,相差1.9～4.4 cm。髋关节Harris评分为(50.7±8.6)分。结果术后患者切口均Ⅰ期愈合;1例1髋发生髋关节后脱位。29例均获随访,随访时间2年～4年6个月,平均2.3年。术后下肢延长0.5～5.8 cm,平均2.5 cm。术后1年髋关节Harris评分为(87.7±5.9)分,与术前比较差异有统计学意义(t=21.77,P=0.00)。X线片检查示,术后1例1髋髋臼杯假体松动,1例1髋髋臼杯假体外移且外展角过大;其余患者随访期间无髋臼杯及股骨假体松动和下沉。术后1年髋臼中心水平位置、髋臼中心与泪滴连线垂直距离、髋臼垂直外展角、股骨偏心距均较术前显著改善,差异均有统计学意义(P<0.05)。结论对DDH行THA时重建髋臼中心能有效延长患者肢体,提高关节功能,降低关节置换失败率。     

CT分型指导成人髋臼发育不良的全髋置换

[目的]探讨成人髋关节发育不良的CT分型,以指导人工全髋关节置换的手术操作.[方法]收治髋臼发育不良伴严重骨性关节炎或股骨颈骨折的Crowe Ⅰ型患者63例,行双髋置换10例,术前常规行X线和三维CT明确诊断及髋臼侧和股骨侧有无畸形及程度并进行分型,根据新的分型合理设计手术方案.术后及随访X线片评价假体位置、有无移位、松动、假体周围骨折及肢体长短.[结果]平均随访3.3年,术后无切口或深部感染,无假体周围骨折及神经损伤,所有患者Harris评分由置换前的(37.9±6.9)分提高到术后近期的(91.2±2.8)分.除早期2例(占总数占2.7％)因术后脱位行二期翻修外;余71例(97.3％)经长期随访,X线示股骨柄和髋臼杯的位置以及与周围的骨质匹配整合良好.63例患者中,术前37例肢体不等长,术后34例等长,短缩＜1 cm3例.[结论]对于髋臼发育不良的患者,新的CT分型,能更好的处理髋臼及股骨近端的畸形,指导选择合适的假体,获得理想的术后功能.     

全髋置换术治疗髋关节发育不良

目的探讨髋关节发育不良(DDH)全髋关节置换术的临床方法与疗效。方法对48例DDH继发骨性关节炎的患者(56髋)进行全髋关节置换术。其中CroweⅠ型24髋,Ⅱ型19髋,Ⅲ/Ⅳ型13髋。术前应用影像学方法评估髋臼和股骨的形态学变化。手术采用常规髋关节置换术,恢复髋关节旋转中心35例(40髋),采用自体股骨头结构性植骨重建髋臼旋转中心6例(8髋),髋臼假体内置5例(6髋),高位重建髋臼2例(2髋)。结果 48例均获得随访,时间3个月～8年。关节假体稳定,关节功能正常,双下肢短缩均有明显改善,未出现感染、脱位、神经损伤并发症。Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者按Harris髋关节评分,分别由术前的(47.3±6.5)分、(42.7±5.5)分和(38.6±7.8)分增加到术后的(92.4±4.1)分、(88.2±4.7)分和(83.9±6.6)分,与术前比较差异有统计学意义(P<0.05)。结论对成人DDH按照Crowe分型采用不同方法行全髋关节置换,是一种可靠而有效的方法。充分的软组织松解、重建髋臼和股骨近端的结构以及正确选择假体是手术成功的关键。     

髋臼加深全髋置换治疗成人先天髋臼发育不良

目的：探索成人先天性髋臼发育不良伴髋关节半脱位的手术治疗方法。材料和方法：12例成人先天性髋臼发育不良伴髋关节半脱位患者采用髋臼加深髋关节置换的方法治疗。结果：经1－8年随访,段体稳定,髋关节疼痛症状消失,关节功能基本正常。结论：髋臼加深全髋关节置换是成人先天性髋臼发育不良伴髋关节半脱位的有效治疗方法。     

成人髋臼发育不良全髋置换的髋臼重建

目的探讨应用全髋关节置换术治疗髋臼发育不良继发骨性关节炎时臼杯假体安放的方法及其对手术疗效的影响。方法对48例(56髋)髋臼发育不良行全髋置换时,部分应用髋臼内陷成形术向内或内下方加深髋臼并选择小型臼杯假体。通过Ranawat三角测量术前及术后股骨头中心距理想旋转中心的水平和垂直距离,应用Mark髋臼四分法判断臼杯假体的实际位置。行Harris临床评分及X线检查做为疗效判定标准。结果Ranawat三角测量,术前股骨头中心距理想旋转中心的水平距离平均为18.2 mm,术后为1.52 mm;术前垂直距离平均为10.26 mm,术后为5.68 mm。手术前后比较,差异有统计学意义(P<0.01)。Mark髋臼四分区中,臼杯假体位于内侧区者为46髋,其中内下区34髋。术前Harris评分为32.5～60.3分,术后为76.6～96.5分。无假体松动和移位,无翻修病例。结论在髋臼发育不良行全髋置换的髋臼重建中,应强调向内方或内下方加深髋臼,接近于真臼安放臼杯假体,以尽量恢复髋关节理想旋转中心;选择小型臼杯假体以获得髋臼宿主骨的良好覆盖,减少髋臼植骨的机会。     

全髋置换术治疗髋关节发育不良的髋臼重建

髋关节发育不良患者合并髋关节骨性关节炎出现髋关节疼痛与活动受限时,通常需要行人工全髋关节置换术,其髋臼重建方法包括结构性植骨、高髋臼旋转中心、旋转中心内移等,但如何针对不同的病例选择合适的方法存在较大争议。2001年6月至2006年6月,对35例（38髋）髋关节发育不良行全髋关节置换术,现报告如下。     

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。     

Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip

The precise relationship between developmental dysplasia of the hip and dislocation among patients after total hip arthroplasty has not been well clarified. A total of 820 patients with developmental dysplasia of the hip who underwent total hip arthroplasty from January 2000 to December 2009 were categorized according to Crowe classification, and postoperative dislocation rates were analyzed among subgroups. The overall dislocation rate was 2.93%. No statistically significant differences in dislocation rates were observed between these with and without subtrochanteric osteotomy. Femoral head size was the only factor with significant difference between the dislocated and stable groups, especially when femoral head diameter increased from 28 to 32 mm. Of all dislocations, 69.6% were anterior dislocation, and the degree of cup anteversion and combined anteversion of anterior dislocators was higher than that of the posterior dislocators (P = .0082 and P = .001).     

成人发育性髋关节发育不良人工全髋关节置换术

目的 探讨人工全髋关节置换术(THA)治疗成人发育性髋关节发育不良(DDH)伴骨关节炎的手术方法和疗效. 方法 2000年1月至2008年6月,采用THA治疗DDH伴骨关节炎45例47髋.其中Crowe Ⅰ型8髋,Ⅱ型18髋,Ⅲ型15髋,Ⅳ型6髋.手术采用外侧入路,术中行髋周软组织松解、延长患肢以恢复真臼重建. 结果所有患者均获随访,时间6个月～5年,平均26个月.术前Harris评分28～63分,平均45分;术后Harris评分82～95分,平均87分,较术前有明显提高(P<0.05).优33髋,良10髋,可4髋,近期优良率达到91.5%.所有患者髋关节疼痛均得到缓解,活动功能满意,无假体松动及翻修病例. 结论 THA是治疗成人DDH伴严重骨关节炎的有效方法.术前充分准备、术中实行有效地软组织松解以及最大程度地恢复患髋的解剖形态和生理功能是重建髋臼和稳定髋臼假体的良好基础,正确选择和安放合适的假体是取得满意疗效的关键.     

Early results of total hip arthroplasty in patients with developmental dysplasia of the hip compared with patients with osteoarthritis

We have investigated the results of primary total hip arthroplasty (THA) performed in patients with developmental dysplasia of the hip (DDH). Through the New Zealand Joint Registry, we identified all patients with DDH undergoing primary THA (n = 1205) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Postoperative outcomes, baseline information, and operative characteristics were analyzed and compared between the DDH and the OA groups. There was no significant difference in Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in DDH, with comparable functional outcomes and revision rates to THA performed for primary OA.     

Outcome of revision hip arthroplasty in patients with a previous total hip replacement for developmental dysplasia of the hip

Our aim was to determine if the height of the cup, lateralisation or the abduction angle correlated with functional outcome or survivorship in revision total hip replacement in patients with a previous diagnosis of developmental dysplasia of the hip. A retrospective investigation of 51 patients (63 hips) who had undergone revision total hip replacement was performed. The mean duration of follow-up was 119 months. Forty-one patients (52 hips) were available for both determination of functional outcome and survivorship analysis. Ten patients (11 hips) were only available for survivorship analysis.The height of the cup was found to have a statistically significant correlation with functional outcome and a high hip centre correlated with a worse outcome score. Patients with a hip centre of less than 3.5 cm above the anatomical level had a statistically better survivorship of the cup than those with centres higher than this. Restoration of the height of the centre of the hip to as near the anatomical position as possible improved functional outcome and survivorship of the cup.     

Transverse subtrochanteric shortening osteotomy in primary total hip arthroplasty for patients with severe hip developmental dysplasia

Twenty-four total hip arthroplasties were performed on patients with Crowe grade 3 or 4 hip dysplasia using subtrochanteric shortening osteotomy with 2 kinds of femoral stems. The average age of the patients was 44.8 years, and their average length of follow-up was 4.7 years. Acetabular reconstruction with structural autograft was used in 11 hips. Radiologically, hip centers were nearly normalized by a vertical height of 10.6-mm elevation and a horizontal length of 1.7 mm as compared with uninvolved sites. Three osteotomy nonunions required revisions with bone graft. One acetabular revision was performed for migration. One postoperative dislocation was managed successfully with closed reduction and an abduction brace. However, no neurologic complication was noticed. The Harris hip score improved from 35.6 to 81.7. A cementless modular distal fluted femoral stem is a useful device in these patients.     

严重髋关节发育不良的全髋关节置换术

目的 评价初次全髋关节置换术治疗伴有晚期髋关节病变的髋关节发育不良患者的临床效果,探讨其技术可行性及操作要点.方法 回顾性分析2002年3月至2008年6月因严重髋关节发育不良而行初次全髋关节置换术的35例患者的临床和影像学资料.男11例11髋,女24例28髋;平均年龄(52±6.7)岁.CroweⅢ型27例31髋,Ⅳ型8例8髋.术前平均Harris评分(42.5±5.3)分.均采用非骨水泥型全髋关节假体.结果 全部患者随访1～7年,平均46个月.末次随访时Harris评分(86.3±3.4)分,与术前比较差异有统计学意义.优33髋,良5髋,可1髋,优良率97.4%.随访期间未发现髋臼假体周围透光带及松动表现.2例出现术中髋臼骨折,根据骨折稳定性,经多枚螺钉或结构性植骨后卧床6周愈合.3例出现下肢深静脉血栓,经溶栓治疗后血栓消失.5例6髋出现Brooker Ⅰ级或Ⅱ级异位骨化.1例于术后1年因外伤发生假体远端骨折.结论 对伴有晚期髋关节病变的严重髋关节发育不良患者行初次全髋关节置换术时,术前应进行精确测量与评估,术中彻底松解软组织,正确处理髋臼和股骨,术后近期临床效果良好.     

Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia

We describe the problems with positioning the hip center according to the severity of dislocation in 97 cementless total hip arthroplasty for developmental dysplasia of the hip. The mean location of the hip center from the interteardrop was 30.4 +/- 8.7 mm horizontally and 23.4 +/- 5.4 mm vertically. The presence of a limp correlated with a superior placement of the cup. Four cups were revised, 2 of which with a significant high hip center. The survival rate of the acetabular component was 95% at 12 years. Craniopodal repositioning was easy in class 1. In class 2, the cup was the largest. In class 3, the greatest variations of the hip center were found. In class 4, the smallest implants were necessary for positioning in the true acetabulum.     

髋臼发育不良全髋关节置换术中髋臼的重建

[目的]总结先天性髋臼发育不良继发骨性关节炎患者全髋关节置换术中髋臼重建的经验。[方法]2001年2月～2006年2月对45例成人髋臼发育不良继发骨性关节炎患者行全髋关节置换术,女40例,男5例,平均年龄52岁(40～63岁)。根据术前髋关节正位X线片分型,CroweⅠ型25例,CroweⅡ型10例,CroweⅢ型5例,CroweⅣ型5例。臼杯均在真臼位置生物压配固定。髋臼常规重建16例,加深髋臼至卵圆窝以内压配固定16例,,股骨头植骨8例,髋臼内壁截骨5例。于术后3、6、12个月,以后每年随访一次。摄X线片观察臼杯松动、植骨愈合情况。检查患者Trendelenburg征的变化,对髋关节功能进行Harris评分。[结果]完整随访41例,平均随访6年(3～8年)。旋转中心上移从术前(2.3±0.8)cm下降为术后(0.8±0.4)cm,P0.05。Harris评分从术前(64±7.8)分提高到术后(93±6.2)分,P0.05。Trendelenburg征阳性患者,从术前38例下降到术后5例。有5例X线表现臼杯松动,但无临床症状。2例植骨块明显吸收。1例因内衬破裂行翻修术。3例术后脱位,闭合复位后未再脱位。[结论]根据髋臼缺损的程度不同采用不同的重建方法,可获得臼杯的充分包容,近期疗效令人满意。