成人髋关节发育不良髋臼解剖学特征及临床意义

目的观察成人髋关节发育不良（DDH）终末期骨性关节炎患者的髋臼解剖形态特征，探讨在人工全髋关节置换术（THR）中各型髋臼缺损发生的特点和重建方法。方法回顾性分析2003年3月—2012年9月60例72髋成人DDH终末期骨性关节炎患者行THR患者的临床资料，观察髋臼解剖形态特征；并以髋臼中心为同心圆，Harris窝底为深度磨削髋臼塑形后，观察髋臼缺损的特点。根据缺损大小和对髋臼假体初始稳定性的影响分别行不植骨、骨泥植骨和结构性植骨治疗。结果72髋中，20髋呈浅杯状，其中CroweI型14例、CroweⅡ型4例、CroweⅣ型2例，髋臼缺损〈10％者15髋、10％～30％者5髋；22髋呈浅盘状，其中CmweI型2例、CmweⅡ型16例、CroweⅢ型4例，髋臼缺损〈10％者2髋、10％-30％者16髋、〉30％者4髋；20髋呈贝壳状，其中CroweⅡ型5例、CroweⅢ型17例，髋臼缺损〈10％者1髋、10％-30％者5髋、〉30％者14髋；10髋呈三角状，均为CroweⅣ型，髋臼缺损〈10％者8髋、10％～50％者2髋。髋臼缺损〈10％者，髋臼假体稳定，未植骨；10％-30％者，髋臼假体较稳定，骨泥植骨；〉30％者髋臼假体不稳定，行结构性植骨后假体稳定。结论成人DDH终末期骨性关节炎的髋臼具有浅杯状、浅盘状、贝壳状和三角状4种解剖形态，这些异常解剖形态的发生除与先天性发育缺陷和后天长期的异常力学环境有关，还与股骨头脱位程度有关；在人工THR中，应根据不同形态髋臼缺损发生的特点和对髋臼假体稳定性的影响确定髋臼重建方法。

Anatomical characteristics and clinical significance of acetabulum in adult developmental dysplasia of the hip

Objective To observe the acetabular anatomical features of end-stage osteoarthritis in adult developmental dysplasia of the hip（DDH） and discuss the characteristics and acetabular reconstruction of each acetabular defect that occurred in total hip replacement （THR）. Methods From March 2003 to September 2012, 72 hips of 60 patients with end-stage osteoarthritis of adult DDH were performed THR. Acetabular anatomical and acetabular defect characteristics were observed after the grind acetabulum with depth of bottom of Harris fossa and with concentric round at the center of acetabulum. According to the defect size and the impact on the acetabular prosthesis initial stability, the patients were performed operation with no bone graft, morselized allograft and structural bone graft. Results In 72 hips, 20 hips were found to be the shape of shallow cup, which included 14 cases of Crowe [ type, 4 cases of Crowe 11 type and 2 cases of Crowe IV type. In these hips, the acetabular defect less than 10% was 15 hips, from 10% to 30% was 5 hips. Twenty-two hips were found to be the shape of shallow dish, which included 2 cases of Crowe I , 16 cases of Crowe ]I type and 4 cases of Crowe III type. In these hips, the acetabular defect less than 10% was 2 hips, from 10% to 30% was 16 hips, more than 30% was 4 hips. Twenty hips were found to be the conchoidal shape, which included 3 cases of Crowe II and 17 cases of Crowe HI type. In these hips, the acetabular defect less than 10% was 1 hip, from 10% to 30% was 5 hips, more than 30% in 14 hips. Ten hips were found to be the triangular shape, found only in Crowe IV type, in which the acetabular defect less than 10% was 8 hips, from 10% to 30% was 2 hips. In the patients with acetabular defect less than 10%, the acetabular prosthesis was stability, no bone graft was needed. The acetabular prosthesis is less stable in the patients with acetabular defect from 10% to 30%, the morselized allograft was performed. The acetabular prosthesis was not stable in the patients with acetabular defect more than 30%, the structural bone graft was performed. Conclusions The acetabulum of end-stage osteoarthritis in adult developmental dysplasia of the hip shows four anatomical shapes of shallow cup, shallow dish, shell and triangle. The acetabular reconstruction method should be detemined according to the acetabular defect characteristics and the impact on the acetabular prosthesis initial stability in total hip arthroplasty.