成人DDH患者保髋手术失败后的THA疗效分析

目的回顾性分析保髋手术治疗失败后的成人发育性髋关节发育不良患者再次行全髋人工关节置换术的中期疗效。方法选择2014年1月至2019年1月收治的22例(30髋)保髋手术失败后行全髋人工关节置换术(total hip arthroplasty,THA)的发育性髋关节发育不良患者作为研究对象,其中男7例,女15例;行保髋手术时年龄1~18岁,平均(7.9±3.4)岁;行THA时年龄22~63岁,平均(34.2±11.2)岁;单髋14例,双髋8例,左髋16侧,右髋14侧。手术前后采用Harris髋关节评分系统及疼痛视觉模拟评分法(visual analogue score,VAS)进行评价,并对手术前后的X线片进行分析。结果本研究病例全髋人工关节置换术后平均随访时间为(30.5±18.5)个月。全髋人工关节置换术后,Harris总评分从术前的平均(38.7±10.6)分提高至末次随访时的(89.4±9.7)分,差异有统计学意义(t=19.67,P<0.001),且患者的疼痛、行走、功能、活动度等各项指标的术后评分均高于术前且差异有统计学意义;疼痛VAS评分由术前的平均(7.9±0.9)分降低到末次随访时的(1.4±1.0)分,差异有统计学意义(t=30.67,P<0.01);患者双下肢长度差异由术前的平均(3.32±0.51)cm降低到术后(0.71±0.33)cm,差异有统计学意义(t=14.01,P<0.001)。所有患者均无发生手术切口及假体周围感染、假体松动、髋关节脱位、血管神经损伤、深静脉血栓及异位骨化等术后并发症,仅2例患者术中出现股骨近端纵行劈裂。结论保髋手术失败后的成人发育性髋关节发育不良患者行全髋人工关节置换术可获得满意的中期疗效。

Analysis of the Effect of Total Hip Arthroplasty after Failed Hip Preservation Surgery in Adult Patients with Developmental Dysplasia of the Hip

Objective To retrospective analysis of the mid-term effect of total hip arthroplasty in adult DDH patients after failed hip preservation surgery.Methods 22 patients(30 hips)with developmental dysplasia of the hip who underwent total hip arthroplasty after failed hip preservation surgery from January 2014 to January 2019 were selected as the study subjects.Harris hip score system and visual analog score(VAS)were used to evaluate before and after surgery,and X-ray films were analyzed before and after surgery.Results The average follow-up time for total hip arthroplasty in this study was(30.5±18.5)months.After total hip arthroplasty,the Harris overall score was improved from(38.7±10.6)preoperatively to(89.4±9.7)at the last follow-up and the difference was statistically significant(t=19.67,P<0.001).The postoperative scores of pain,walking,function,and activity were higher than those before surgery and the difference was statistically significant;The pain VAS score had decreased from the average(7.9±0.9)points before surgery to(1.4±1.0)at the last follow-up and the difference was statistically significant(t=30.67,P<0.01).The difference in the length of the lower limbs of the patients decreased from the average(3.32±0.51)cm before surgery to(0.71±0.33)cm after surgery,and the difference was statistically significant(t=14.01,P<0.001).All patients had no postoperative complications such as surgical incisions and periprosthetic infections,loosening of the prosthesis,hip dislocation,vascular and nerve damage,deep vein thrombosis and ectopic ossification;only 2 patients had longitudinal femoral proximal split line in surgery.Conclusion Total hip arthroplasty in adult patients with developmental dysplasia of the hip after hip preservation surgey can achieve satisfactory mid-term results.