髋臼内壁截骨在成人发育不良髋关节置换中的应用：8例分析

回顾性分析2004-09/2006-11南昌大学第二附属医院骨科收治的髋关节发育不良患者8例(8髋)，男2例，女6例，年龄35~65岁，平均46岁；置换前行X射线摄片及CT检查，提示所有患者患侧髋臼角(Sharp角)均> 45°，股骨头包容不良，关节间隙缩窄，shenton线连续性欠佳。按Crowe分期，CroweⅡ期5例5髋，CroweⅢ期3例3髋。置换前Harris评分44~62分，平均50分。全部患者均采用全髋置换，假体采用非骨水泥或混合型固定模式，其中非骨水泥生物固定者6髋，水泥固定者2髋。所有患者髋臼侧均采用髋臼内壁截骨内移法安放髋臼假体。记录置换时间，置换过程中出血量，置换后住院天数，Harris评分及围置换期并发症；置换后临床随访观察截骨断面及植骨块愈合情况。8例患者均获得随访，平均6个月，全部患者关节功能恢复良好，随访病例中未出现感染、坐骨神经损伤、髋关节脱位、股骨干骨折、深静脉血栓、假体松动等并发症。置换后6个月Harris评分86~94分，平均88分。置换后3个月X射线平片提示截骨断面及植骨块愈合良好。提示髋臼内壁内移截骨全髋置换治疗髋关节发育不良作用明显，早中期效果良好。

Acetabular medial wall displacement osteotomy in total hip arthroplasty for treatment of adulf hip dysplasia

The present study retrospectively analyzed 8 patients with hip dysplasia (8 hips) comprising 2 males and 6 females, aged 46 years old (range, 35-65 years old) who received treatment at the Department of Orthopedics, Second Affiliated Hospital of Nanchang University between September 2004 and November 2006. Preoperative radiographs and CT examination showed that all patients presented with sharp angle of affected hip > 45°, poor containment of femoral head, narrow joint space, and non-successive Shenton's line. Following Crowe classification, there were 5 cases (5 hips) of grade II, and 3 cases (3 hips) of grade III. Preoperative Harris hip score was 50 points (range, 44-62 points). Total hip arthroplasty was employed in each patient. Prosthesis was fixed by Cementless or cemented modes. Cementless fixation was applied in 6 hips and cemented fixation in 2 hips. Cementless prosthesis was used on the affected side in each patient. Replacement time, bleeding volume during surgery, hospital days post-surgery, Harris scores, and peri-operative complications were recorded. Simultaneously, post-surgery healing was observed. All 8 cases were followed up for an average period of 6 months. All patients exhibited well recovered joint function. No infection, sciatic nerve injury, dislocation of hip joint, fracture of femoral shaft, thrombosis of deep veins, or prosthesis loosening were found in any follow-up case. Six months after surgery, Harris hip score was 88 points (range, 86-94 points). Radiographs taken at 3 months post-surgery displayed the bone union of surgical region. All these findings suggest that acetabular medial wall displacement osteotomy in total hip arthroplasty produces obvious early- and middle-stage effects in treatment of hip dysplasia.