髋臼重建治疗Crowe Ⅲ型髋臼发育不良

目的 探讨髋臼重建治疗Crowe Ⅲ型髋臼发育不良的手术方法及疗效.方法 2001年1月至2007年6月43例(54髋)Crowe Ⅲ型髋臼发育不良继发骨关节炎患者接受全髋关节置换术治疗.术前Harris评分平均39分.髋臼重建方法包括单纯加深或穿透髋臼(A组)27例(34髋)、髋臼内壁截骨(B组)12例(15髋)、髋臼自体股骨头植骨(C组)4例(5髋).分别记录每种重建方法的手术时间、出血量、并发症.术后随访进行放射学及临床疗效评估.结果 40例(50髋)患者获得完整随访,随访时间平均29个月.在术后3～5个月随访时截骨和植骨已愈合.摄x线片测量A、B、C组重建方式的髋臼外倾角分别为(41.0±7.5)°,(46.0 ±7.7)°,(39.0±11.0)°;前倾角分别为(10.0±2.8)°,(9.0±2.5)°,(4.0±1.9)°;旋转中心上移分别为(8.4±3.6)mm,(7.3 ±2.6)mm,(1.2±0.5)mm;旋转中心内移分别为(7.0±1.5)mm,(9.9 ±1.7)mm,(-2.7 ±1.2)mm.A、B、C组末次随访平均Harris评分分别为B9、91、86分.随访患者中2例发生下肢深静脉血栓,2例可疑肺栓塞,4例坐骨神经麻痹.结论 单纯加深或穿透髋臼、髋臼内壁截骨、自体股骨头植骨是Crowe Ⅲ 型髋臼发育不良髋臼重建的有效方法.应根据术前评估、术中具体情况采用相应的重建方法.

Reconstruction of the acetabular in the Crowe Ⅲ dysplastic hip

Objective To investigate the method and the outcome of the acetabular reconstruction in the Crowe Ⅲ dysplastic hip.Methods From January 2001 to June 2007,43 cases ( 54 hips) were diagnosed esteoarthritis secondary to Crowe Ⅲ dysplnstic hip.Total hip arthroplasty was performed in all cases.The Harris score was 39 preoperation.The method of the acetabular reconstruction included aeetabular deepening (group A ), medial-waft esteotemy (group B ), femoral head bone grafting (group C).Radiography data and Harris score were taken to evaluate the clinical outcome.Results The method of the acetabular reconstruction included scetabular deepening in 27 cases (34 hips), medial-wall osteotemy in 12 cases (15 hips), femoral head bone grafting in 4 cases (5 hips).Forty cases were followed up by the mean time of 29 months. The bone union time of the esteotomy and bone grafting were 4-5 months postoperation.In the three groups the obliquity angle of the cup were (41.0 ± 7.5 ) °,(46.0 ± 7.7)°, (39.0±11.0)°;the anteversion angle of the cup were (10.0±2.8)°,(9.0±2.5)°,(4.0±1.9)°;the rotation center of the hip was shift superiorly (8.4 ±3.6)mm, (7.3 ± 2.6)mm, (1.2±0.5)mm; the rotation center of the hip were shift internally (7.0±1.5 )mm, (9.9±1.7)mm, (-2.7±1.2)mm, and the Harris score were 89, 91, 86 at the follow up.The complication included deep venous thrombosis in 2 cases, pulmonary embolism in 2 cases, sciatic nerve palsy in 4 cases.Conclusion Acetabular deepening,medial-wall osteotemy, femoral head bone grafting can be used in reconstruction of the scetabular in the Crowe Ⅲ dysplastic hip.