结构植骨重建髋臼在髋关节发育不良全髋置换中的应用

目的 评价自体股骨头结构植骨重建髋臼在髋关节发育不良的全髋关节置换术中的效果。方法 选取2005年1月至2010年11月对髋Crowe分型在Ⅲ型和Ⅳ型的髋关节发育不良患者25例31髋，34~69岁，平均52岁；Ⅲ型15例19髋，Ⅳ型8例10髋；采用结构植骨重建髋臼的全髋关节置换术。术中行股骨头结构植骨，保证覆盖率的基础上，于真臼或近真臼水平重建髋臼并安装假体。术后行影像学检查和Harris评分。成功随访23例29髋，平均随访5.1年。结果 植骨愈合良好，无植骨塌陷，1例1髋术后脱位，所有病例无假体松动发生。术前Harris评分平均44分，术后1年平均89分，最后1次随访平均88分。结论 应用自体股骨头结构植骨，满足覆盖率前提下在真臼位置重建髋臼行全髋关节置换，对髋臼发育不良的患者术后髋关节的功能具有安全有效的意义。

Structural autograft for acetabular reconstruction in total hip arthroplasty of developmental hip dysplasia

Objective To evaluate the result of bulk femoral head autograft for acetabular reconstruction in total hip arthroplasty for developmental hip dysplasia patients with severe acetabular deficiency. Methods Twenty-five-patients(31 hips) with development hip dysplasia were performed with bulk femoral head autograft for the acetabular reconstruction in THA during 2005-2010. Twenty-nine hips in 23 patients were successfully followed up in average 5.1 years with mean age of 52. According to Crowe classification, 19 hips in 15 patients were stage III and 10 hips in 8 patients were stage IV. The deficient acetabula were reconstructed by bulk femoral head autograft. With bone guaranteed coverage, patients had prosthesis installed at the original level or closed level of true acetabulum. Radiographic changes and Harris score were evaluated. Results None suffered from loosening and collapse during the follow-up. One was revised for dislocation. Harris scores increased from 44 preoperative to 88 at last follow-up. Conclusion To reconstruct acetabulum at true acetabular level with satisfactory bone coverage by using bulk femoral head autograft is an effective and safe way for THA in developmental hip dysplasia.