生物型全髋关节置换术治疗成人髋关节发育不良29例回顾性分析

目的：分析生物型全髋关节置换术治疗成人髋关节发育不良伴骨性关节炎的临床治疗效果。方法：自2004年3月至2011年2月对29例32髋先天性髋关节发育不良伴骨性关节炎患者行生物型全髋关节置换术。其中男l】例，女18例；年龄37-73岁，平均52．6岁；单侧26例，双侧3例。主要症状为髋部疼痛及跛行。根据术前髋关节正位X线片分型，Crowe分型：I型17例18髋，Ⅱ型6例7髋，Ⅲ型3例4髋，Ⅳ型3例3髋。术前除3例双侧髋关节发育不良外，余患者下肢不等长1-6cm。结果：29例术后无感染、关节脱位、坐骨神经牵拉伤等并发症发生，1例股骨近端劈裂者，术中用钢丝捆扎，术后4年随访，骨折愈合，未发生假体松动迹象。所有植骨块及粗隆下截骨获得愈合，所有患者术后获随访，时间8个月-5．3年，平均3．7年。21例髋部疼痛消失、关节功能恢复良好；5例仍有轻度跛行，但较术前明显减轻。3例术后双下肢不等长〉1cm，其余均≤1cm，2例下肢延长4～5cm。Harris评分由术前的43．6±7．1提高至术后的86．7±5．3。结论：在真臼位置加深髋臼重建髋关节，根据Crowe分型不同特点，采用不同的手术方案，利用生物型全髋关节置换术治疗成人髋关节发育不良可获得良好效果。

Retrospective analysis on total hip arthroplasty for the treatment of developmental dysplasia of the hip in 29 adults

Objective：To study the results of the total hip arthroplasty （THA） in the treatment of developmental dysplasia of the hip （DDH） with severe osteoarthritis in adults. Methods：From March 2004 to February 2011,29 patients （32 hips） with DDH were treated by THA with an cementless cup. There were 11 males and 18 females ,with an average age of 52.6 years （ranging from 37 to 73 years）. Unilateral DDH occurred in 26 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification,there were 18 hips in 17 patients of type I ,7 hips in 6 patients of type lI ,d hips in 3 patients of type m, 3 hips in 3 patients of type IV. Except for 3 patients with bilateral DDH,the other patients＇ ill lower limbs were 1 to 6 cm shorter than the healthy lower ones. Results：All the patients were followed up, and the duration ranged from 8 months to 5.3 years （averaged 3.7 years） without infection, dislocation, and sciatic nerves injury after the operation. One patient with proximal femoral fracture,intraoperation used wire binding, after 4 years of follow-up, fracture healed without evidence of prosthesis loosening. All grafts and subtrochanteric osteotomy healing were achieved. In 21 patients, the pain was completely relieved and the function of the hip joints was good. Five patients still had mild limping, but reduced significantly than preoperation. In 3 patients ,the ill lower limbs were more than 1 cm shorter than the healthy lower ones and the other patients＇ ill lower limbs were less than 1 cm shorter than the healthy lower ones. Two patients＇ lower limbs were lengthened 4 to 5 cm. The Harris scores were 43.6±7.1 preoperatively and 86.7±5.3 postoperatively （P〈0.05）. Conclusion：THA with deepening the medial wall of the acetabulum at the true acetabulum, according to different characteristics of Crowe classificati on, using different operation program, cementless cup in adult could obtain favorable results.