转子下截骨全髋关节置换治疗Crowe Ⅳ型髋关节发育不良的围手术期并发症

目的 分析转子下截骨全髋关节置换治疗Crowe Ⅳ型髋关节发育不良的围手术期并发症.方法 2002年6月至2009年8月,因Crowe Ⅳ型髋关节发育不良接受股骨转子下截骨全髋关节置换术35例42髋,男11例,女24例;年龄28～68岁,平均(47.4±9.61)岁.回顾性分析围手术期并发症的类型、发生率及导致并发症的相关因素.结果 全部病例随访3～84个月,平均24.3个月.术前Harris评分平均(60.42±14.41)分,末次随访平均(81.58±26.96)分,差异有统计学意义(t=-2.3545,P=0.0382).共18髋发生并发症21髋次,并发症发生率42.9%(18/42);其中20髋次出现于2008年以前的病例,并发症发生率65.4%(17/26).包括骨折11髋(26.2%),血管并发症2髋(4.8%),神经并发症4髋(9.5%),截骨不愈合2髋(4.8%),术后脱位及假体松动各1髋(2.4%).行预防性钢丝环扎的10髋均未出现骨折,未行预防性环扎32髋中11髋出现骨折,两组差异有统计学意义(χ~2=4.657,P=0.031).Hartofilakidis C1型髋关节发育不良患者围手术期并发症发生率为55.0%(11/20),C2型为23.1%(3/13),差异无统计学意义(χ~2=3.287,P=0.070).结论 对Crowe Ⅳ型髋关节发育不良行转子下截骨全髋关节置换并发症发生率高.周密的术前设计和规范的手术操作可减少围手术期并发症的发生.

Total hip arthroplasty with shortening subtrochanteric osteotomy for severe developmental dysplasia of the hip

Objective To evaluate the complications of total hip arthroplasty (THA) with a shortening subtrochanteric osteotomy in a group of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH), and to refine surgical techniques to decrease the incidence of the complications. Methods From Jun. 2002 to Aug. 2009, 35 patients (42 hips) with Crowe type Ⅳ DDH underwent DDH, including 24 females and 11 males, with the mean age of (47.4±9.61) years. The results and complications were evaluated retrospectively. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. Results The mean Harris hip score increased from 60.42±14.41 points preoperatively to 81.58±26.96 points at the time of final follow-up (P=0.0382). Eighteen of the 42 hips (42.9%) had a peri-operative complication. Eleven perioperative fractures happened. Two hips were followed by nonunion. Four nerve injuries and two vascular injuries occurred. One hip dislocated postoperatively. All components were well-fixed at the time of the last radiographic follow-up except one femur stem loosened. Avoidance of over or under reaming, appropriating osteotomy level and prophylactic cerclage wiring were associated with low complication rate. Conclusion Subtrochanteric osteotomy, performed in THA for osteoarthritis secondary to Crowe type Ⅳ DDH, is a highly complicated surgical procedure. Appropriate prosthesis selection and meticulous surgical techniques is mandatory and efficient to decrease the complication rates.