植骨加盖行生物学固定型全髋关节置换治疗严重成人髋关节发育不良

背景：由于髋关节的异常变，使关节置换手术难度加大、处理困难，其中又以髋臼侧为甚。因此，对髋关节发育不良患者施行全髋关节置换时，对髋臼的处理尤为重要。目的：探讨采用植骨加盖行生物学固定型全髋关节置换治疗 CroweⅢ、Ⅳ型成人髋关节发育不良患者的临床疗效。方法：回顾分析14例髋关节发育不良成人患者，按Crowe方法分型Ⅲ型11例，Ⅳ型3例。所有患者均进行全髋关节置换，置换过程中采用自体般骨颈在髋臼周围做植骨加盖，对置换后及随访时X射线片的影像学资料进行分析，临床疗效采用Harris标准评定。结果与结论：14例髋关节发育不良成人患者均获得随访，随访时间1-9年，平均4.5年。4例患者置换后1年内植骨块发生部分吸收，2年后又重新生长，所有植骨块经X 射线平片证实均与宿主骨愈合，植骨块对髋臼的平均覆盖率为36%，至今无一髋需行翻修，髋关节功能从置换前Harris评分平均35分（26-52分）恢复至末次随访时的平均91分。证实采用自体股骨颈植骨加盖的生物学固定型全髋关节置换是治疗CroweⅢ、Ⅳ型成人髋关节发育不良的有效方法。

Total hip arthroplasty with onlay bone graft for treatment of severe adult hip dysplasia

BACKGROUND：Joint replacement surgery becomes difficult because of the abnormal changes in hip joint, especial y on the acetabular side. Therefore, the treatment on acetabulum is very important during total hip arthroplasty in patients with hip dysplasia. OBJECTIVE：To investigate the clinical therapeutic effects of total hip arthroplasty with onlay bone graft for treatment of CroweIII and IV adult hip dysplasia. METHODS：A total of in 14 patients with adult hip dysplasia were retrospectively analyzed. According to Crowe method, there were 11 cases of type III and 3 cases of type IV. Al patients underwent total hip arthroplasty. Autologous femur neck was used to make an onlay bone graft around the acetabulum during replacement. Radiographs were analyzed after replacement and during fol ow-up. Clinical efficacy was assessed using Harris standard. RESULTS AND CONCLUSION：Al patients were fol owed up for 1-9 years, averagely 4.5 years. Bone graft was partial y absorbed within 1 year after replacement in 4 patients, and began to grow 2 years later. Radiographs showed that al bone graft was fused to host bone. The average coverage rate of bone grafts on acetabulum was 36%. None hip was needed to be rebuilt up to now. Harris score of hip joint function increased from 35 points （26-52 points） before surgery to 91 points during final fol ow-up. Total hip arthroplasty with onlay bone graft is an effective method in treatment of CroweIII and IV adult hip dysplasia.