非骨水泥型全髋关节置换术治疗成人发育性髋关节脱位

目的 回顾性分析成人发育性髋关节脱位的非骨水泥型全髋关节置换术方法及疗效.方法 1997年12月-2006年10月,采用非骨水泥型全髋关节置换术治疗61例78髋发育性髋关节脱位.男8例,女53例;年龄17～56岁,平均31.4岁.患髋Trendelenburg征阳性.病理分型采用Hartofilakidis等方法,Ⅰ型15例18髋,Ⅱ型23例31髋,Ⅲ型23例29髋.手术采用后外侧入路,臼杯置于真臼或接近于真臼水平.12例股骨头脱位高于真臼5 cm以上的Ⅲ型患者,采用小转子下短缩截骨复位,截骨长度2～5 cm.结果 60例76髋获随访12～118个月,平均49个月.x线片示行臼侧植骨及股骨截骨患者的植骨及截骨处均于术后3～14个月骨性愈合,平均4个月.无臼或柄假体松动,活动度无明显受限,患髋无疼痛,Trendelenburg征阴性.未行股骨截骨者,双下肢等长或接近等长,术前骨盆代偿性倾斜基本纠正,无明显跛行步态.行股骨短缩截骨者,骨盆倾斜较术前减轻,患肢长度较术前延长2.0～4.5 cm.Harrs评分由术前(40.28 ±9.84)分提高至(90.92±2.80)分(P<0.01).1例术后发生股神经牵拉性麻痹,股四头肌瘫,对症处理后4个月恢复.结论 成人发育性髋关节脱位尤其是高位脱位,采用非骨水泥型全髋关节置换手术难度较大,但仍是一种较为理想的治疗方法,能明显改善患者生活质量.

CEMENTLESS TOTAL HIP ARTHROPLASTY FOR DEVELOPMENTAL DISLOCATION OF THE HIP IN ADULTS

OBJECTIVE: To evaluate the operative technique and the short-term clinical effect of cementless total hip arthroplasty (THA) for developmental dislocation of the hip in adults. METHODS: From December 1997 to October 2006, 61 patients (78 hips) with developmental dislocation of the hip were treated with the cementless THA. There were 8 males and 53 females with the average age of 31.4 years (ranging from 17 years to 56 years). According to the classification of Hartofilakidis, 15 cases were type I (18 hips), 23 type II (31hips), and 23 type III (29 hips). All the patients were exposed through the posterolateral approach. The threaded cup with coating was put at or near the level of the true acetabulum in all cases. Full coating stems were used in femoral sides, and shortening osteotomy below trochanter of femur was performed in 12 cases. RESULTS: Sixty patients (76 hips) were followed up with the mean duration of 49 months (range 12 to 118 months). All the hips of osteotomy and bone ingrowth acquired union 3 to 14 months after the operation. No patient had radiographic evidence of aseptic loosening of prosthesis. The average leg length of the hips with femoral shortening osteotomy was lengthened 2.0 to 4.5 cm. All patients had pain relief and no obvious motion limitation, limp gait and pelvic obliquity. The Harris scores were 40.28 +/- 9.84 preoperatively and 90.92 +/- 2.80 postoperatively (P < 0.001). One patient with postoperative femoral nerve palsy completely recovered 4 months after the operation. CONCLUSION: Cementless THA for developmental dislocation of the hip in adults produces significantly better results, although it presents great technical difficulties.