非骨水泥人工关节置换手术治疗髋臼发育不良的临床研究

目的探讨不同分度的髋臼发育不良患者进行关节置换的处理方法。方法自2002～2005年，本组192例全髋关节置换手术的患者中，其中38例45髋存在髋臼发育不良，均行人工关节置换手术，术中按照髋臼发育不良的分度按照不同的原则进行处理。结果38例45髋患者中得到2年以上完整随访资料的有27例30髋，电话随访2年以上的有6例9髋，术后2年完全失访5例6髋。所有得到随访的患者（33例）均表示疼痛得到显著改善，生活质量大大提高（手术前后VAS评分比较，t=31．662，P〈0．01）。27例资料完整的患者（30髋）Harris评分由术前平均54．9分增加到平均92．7分，手术前后Harris评分差异具有统计学意义（t=-31．5，P〈0．01）。未发现关节脱位的患者，使用螺旋臼杯术后1年可见臼杯周围骨质改建；1例患者（球形臼杯、金属对金属）髋臼假体周围可见明显骨质吸收，其余患者影像学阅片未见特殊异常。结论对于发育不良的髋臼，只要术中处理恰当，非骨水泥固定的髋臼假体仍然可以获得良好稳定，一般情况下没有必要进行髋臼上方植骨，对于极度严重发育不良的髋臼才需要植骨稳定假体。

Treatment of acetabular dysplasia with cementless artifical hip replacement

Objective To discuss methods of artifical hip replacement dealing with acetabular dysplasia.Methods 192 operations were performed from 2002 to 2005, including 38 cases(45 hips) of acetabular dysplasia. All the patients were performed THR with different method according to the different grade of acetabular dysplasia. Results 27 patients with 30 hips were followed up face to face, 6 patients with 9 hips were followed up through phone call, and 5 patients with 6 hips were lost. All the patients who could be contacted showed satisfied life quality after the THR(VAS contrast showed t=31.662,P<0.01). No dislocation was found and sclerotin rebuilding could be seen around the spiral acetabular prosthesis one year after the operation. One patient with left acetabular dysplasia was dealt with globular acetabular prosthesis. X-ray showed that bone absorption was obvious around the prosthesis.Conclusions Cementless artificial hip replacement can supply enough stability for THR of dysplasia acetabular. Bone-graft is unnecessary ordinarily and it is only sometimes used for severe dysplasia.