髋关节表面置换术治疗Crowe Ⅰ、Ⅱ型髋关节发育不良

目的研究CroweI型和Ⅱ型髋关节发育不良（DDH）患者行髋关节表面置换术（HRA）的临床结果。方法前瞻性将2005年3月—2006年12月80例CroweI型和Ⅱ型DDH患者随机分入HRA组和全髋关节置换术（THR）组。HRA组中3例改行THR、3例失随访，THR组中2例失随访，故34例37髋接受HRA，38例39髋接受THR。在术后6周、3个月、1年，以后每年1次进行随访，接受放射学及临床评价。结果HRA组和THR组分别平均随访59．4个月（52～70个月）及60．6个月（50—72个月），2组都未出现假体失败。2组间术后Harris评分差异无统计学意义（P：0．073），但HRA组的屈髋活动度显著优于THR组（P〈0．01）。两组间髋臼假体的平均外展角差异无统计学意义（P=0．982）。HRA组的髋臼假体直径大于THR组（49．5ramvs46．1mm，P=0．001）。结论CroweI型和Ⅱ型DDH行HRA的临床结果与THR相近，但HRA术后屈髋活动度更佳，HRA在使用较大股骨假体的同时，髋臼会有额外骨量丢失。

Hip resurfacing arthroplasty for patients with Crowe I and Crowe II developmental dysplasia of the hip

Objective To research the clinical results of hip resurfacing arthroplasty （HRA） for patients with Crowe type I or 1T developmental dysplasia of the hip（DDH）. Methods From March 2005 to December 2006, a total of 80 Crowe type I or II dysplasia hip patients were randomly assigned for HRA or total hip replacement （THR）. Three patients planed for HRA were converted to THR, three HRA patients and two THR patients were lost follow-up. This left a total of 34 patients （37 hips） who underwent HRA and 38 （39 hips） who underwent THR. Radiographic and clinical evaluations were taken 6 weeks, 3months, 1 year and then they were followed up annually. Results The mean follow-up period was 59.4 months （52 to 70） in the HRA group and 60.6 months （50 to 72） in the THR group. There was no failure of the prosthesis in either group. There was no difference in the mean post-operative Harris hip scores between the groups （ P = 0. 073 ） , while hip flexion was significantly better after HRA （ P 〈 0.01 ）. There was no difference in the mean abduction angle of the acetabular component between the two groups （P = 0.982 ） and the mean size of the acetabular component in the HRA group was significantly larger than that in the THR group （49.5 mm vs 46.1 mm, P = 0. 001 ）. Conclusions The clinical result after HRA was similar to that after THR, but flexion of the hip was better after HRA. More acetabular bone will be sacrificed in HRA in compensation for a bigger femoral head.