非短缩截骨全髋关节置换术治疗严重髋关节发育不良

目的 观察非短缩截骨全髋关节置换术治疗髋关节发育不良继发骨关节炎的临床疗效.方法 2004年12月至2008年12月收治20例(21髋)CroweⅢ或Ⅳ型髋关节发育不良继发髋关节骨关节炎患者,男1例,女19例;年龄19～44岁,平均32.1岁.术前Harris评分(44.3±16.7)分.肢体短缩3.0～6.5 cm,平均4.6 cm.采用后外侧入路,行非股骨短缩截骨的全髋关节置换术,其中14例15髋用自体股骨头植骨重建髋臼.术后早期采取屈髋屈膝位松弛坐骨神经和股神经,仅行下肢肌肉静力性收缩训练,逐渐减少屈髋及屈膝角度至伸髋、伸膝正常.髋臼重建患者术后6周避免负重.结果 所有患者随访8～48个月,平均25.3个月.患肢延长2.9～5.3 cm,平均(3.9±0.7)cm;较对侧短缩0～1.6 cm,平均(0.5±0.3)cm.术后下肢肌肉主动静力性收缩均正常,2例出现小腿皮肤麻木感,1个月后恢复.X线片显示假体位置均满意,髋臼重建患者髋臼假体完全骨性覆盖,植骨块与假体及植骨床压配紧密,无髋臼假体松动及植骨块不愈合、吸收.2例出现异位骨化.末次随访Harris评分(86.3±10.7)分,与术前比较差异有统计学意义.结论 非短缩截骨及自体股骨头结构性植骨全髋关节置换术能重建复杂髋关节发育不良的生物学及生物力学,不增加并发症风险.术后早期软组织平衡应逐渐恢复,强调个体化康复方案.

Total hip arthroplasty with acetabular reconstruction and without femoral shortening osteotomy for developmental dysplasia of the hip with complicated deformity

Objective To observe the clinical results of total hip arthroplasty (THA) with acetabular reconstruction and without femoral shortening osteotomy for developmental dysplasia of the hip (DDH) with complicated deformity. Methods Between December 2004 and December 2008, 20 patients (21 hips) with Crowe type Ⅲ, Ⅳ DDH combined with osteoarthritis were treated. The mean age was 32.1 years (19-44 years) and limb shortening 4.6 cm (3.0-6.5 cm), and preoperative Harris score was 44.3±16.7. All cases were accomplished through posterolateral approach and underwent acetabular reconstruction with autograft of femoral bead and periarticular soft tissue releases without sabtroehanteric shortening osteotomy. The limb-length discrepancy, complications and rehibilitation process were observed, and radiographic examination and Harris hip score were recorded. Results All patients were followed up for 8-48 months. The lengthen-ing of the operated limb was 2.9-5.3 cm after THA. The postoperation radiography showed good position of the prosthetic components. All patients had no static contraction abnormality at operated limb. Two patients with numbness in lateral leg after the procedure recovered completely in 1 month. No other complication was observed except heterotopic ossification in 2 patients. At the final follow-up examination, Harris hip score significantly increased to 86.3±10.7. Conclusion THA with aeetabular reconstruction and without shorten-ing femoral osteotomy for DDH with complicated deformity is effective procedure to improve hip function and biomeehanical reconstruction, which ean avoid disadvantage of femoral shortening osteotomy. But post-operative early rehibilitation must be individuation and completed gradually, to avoid nervous and vascular comphcation.