严重髋关节发育不良的全髋关节置换术

目的 评价初次全髋关节置换术治疗伴有晚期髋关节病变的髋关节发育不良患者的临床效果,探讨其技术可行性及操作要点.方法 回顾性分析2002年3月至2008年6月因严重髋关节发育不良而行初次全髋关节置换术的35例患者的临床和影像学资料.男11例11髋,女24例28髋;平均年龄(52±6.7)岁.CroweⅢ型27例31髋,Ⅳ型8例8髋.术前平均Harris评分(42.5±5.3)分.均采用非骨水泥型全髋关节假体.结果 全部患者随访1～7年,平均46个月.末次随访时Harris评分(86.3±3.4)分,与术前比较差异有统计学意义.优33髋,良5髋,可1髋,优良率97.4%.随访期间未发现髋臼假体周围透光带及松动表现.2例出现术中髋臼骨折,根据骨折稳定性,经多枚螺钉或结构性植骨后卧床6周愈合.3例出现下肢深静脉血栓,经溶栓治疗后血栓消失.5例6髋出现Brooker Ⅰ级或Ⅱ级异位骨化.1例于术后1年因外伤发生假体远端骨折.结论 对伴有晚期髋关节病变的严重髋关节发育不良患者行初次全髋关节置换术时,术前应进行精确测量与评估,术中彻底松解软组织,正确处理髋臼和股骨,术后近期临床效果良好.

Primary total hip arthroplasty for treating severe developmental dysplasia of the hip

Objective To evaluate the clinical results of the primary total hip arthroplasty (THA) for treating severe developmental dysplasia of the hip (DDH) and to explore the practicality and operation points.Methods We investigated and analyzed the clinical and X-ray results of 35 severe DDH patients who re-ceived primary THA from March 2002 to June 2008, including 11 males (11 hips) and 24 females (28 hips),with the average age of 52±6.7 years (ranged 45-71 years). According to Crowe classification, 27 patients (31 hips) were classified as type Ⅲ and 8 patients (8 hips) as type Ⅳ. The mean Harris score was 42.5±5.3 pre-operatively. All the patients received non-cemented prosthesis. Results All patients were followed up for average 46 months (1-7 years). The mean Harris score was 86.3±3.4 points at the final follow-up, which had statistic significancy. Among these patients, 33 hips had excellent results, 5 hips had good results and 1 hip had fair results. The rate of excellent and good results was 97.4%. During the follow-up period, there was no radio-lucent line or prosthesis loosening. Two cases suffered acetabuiar fractures during surgery, and were treated with additional screws or structural bone-grafting according to the fracture stability. After 6 weeks,both fractures healed uneventfully. Three patients developed deep vein thrombosis (DVT) and after throm-bolytic therapy, the thrombus disappeared. Heterotopic ossification (Brooker type Ⅰ or type Ⅱ) were found in 5 patients (6 hips), and the rate of beterotopic ossification was 15.4%. One patient suffered femoral frac-ture at the level below the femoral prosthetic tip one year after THA due to injury. Conclusion For the se-vere DDH patients, it's neccesary to make precise measurement and accurate evaluation before primary THA, and do thorough soft tissue releasement during operation, fix the acetabular and femoral prostheses ac-cording to bone character and deal with intraoperative fractures properly. Thus good short-term clinical re-suits can be expected.