生物型全髋关节置换术治疗成人髋关节发育不良

目的 总结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疗效.方法 2000年3月-2006年1月,对24例27髋先天性髋关节发育不良患者行生物型全髋关节置换术.男7例,女17例;年龄26～63岁,平均49.6岁.单侧21例,双侧3例.主要症状为髋部疼痛及跛行.Crowe分型:Ⅰ型15例16髋,Ⅱ型4例4髋,Ⅲ型3例4髋,Ⅳ型2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2～7 cm.结果 24例患者无术后感染、关节脱位、股骨干骨折等并发症发生.术后均获随访9个月～6.5年,平均3.2年.18例髋部疼痛消失、关节功能恢复良好;3例术后跛行,经积极臀中肌锻炼后逐渐消失;3例末次随访时仍有轻度跛行,但较术前明显减轻.3例术后双下肢不等长>1 cm,其余均≤1 cm.2例下肢延长4～5 cm.所有患者均无坐骨神经牵拉伤情况.Harris评分由术前的(46.5±7.2)分提高至(84.0±5.7)分,差异有统计学意义(P<0.05).结论 在真臼位置加深髋臼,选用小号人工臼体的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.

TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN ADULTS

OBJECTIVE: To summarize techniques of the total hip arthroplasty (THA) in the treatment of developmental dysplasia of the hip (DDH) with severe osteoarthritis in adults. METHODS: From March 2000 to January 2006, 24 patients (27 hips) with DDH were treated by THA with an cementless cup. There were 7 males and 17 females, with the average age of 49.6 years (ranging from 26 years to 63 years). Unilateral DDH occurred in 21 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 16 hips in 15 patients of type I, 4 hips in 4 patients of type II, 4 hips in 3 patients of type III, 3 hips in 2 patients of type IV. Except for 3 patients with bilateral DDH, the other patients' ill lower limbs were 2-7 cm shorter than the healthy lower ones. RESULTS: All the patients were followed up from 9 months to 6.5 years and no one had infection, dislocation, femur fracture and so on after the operation. In 18 patients, the pain was completely relieved and the function of the hip joints was good. After the gluteus medius exercise, the claudication of 3 patients after the operation disappeared. 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 been lengthened 4-5 cm. All the patients' sciatic nerves were not injured. The Harris scores were 46.5 +/- 7.2 preoperatively and 84.0 +/- 5.7 postoperatively (P < 0.05). CONCLUSION: THA with deepening the medial wall of the acetabulum at the true acetabulum and choosing small cementless cup in adult could obtain favorable results.