全髋置换术治疗髋关节发育不良

目的探讨髋关节发育不良(DDH)全髋关节置换术的临床方法与疗效。方法对48例DDH继发骨性关节炎的患者(56髋)进行全髋关节置换术。其中CroweⅠ型24髋,Ⅱ型19髋,Ⅲ/Ⅳ型13髋。术前应用影像学方法评估髋臼和股骨的形态学变化。手术采用常规髋关节置换术,恢复髋关节旋转中心35例(40髋),采用自体股骨头结构性植骨重建髋臼旋转中心6例(8髋),髋臼假体内置5例(6髋),高位重建髋臼2例(2髋)。结果 48例均获得随访,时间3个月～8年。关节假体稳定,关节功能正常,双下肢短缩均有明显改善,未出现感染、脱位、神经损伤并发症。Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者按Harris髋关节评分,分别由术前的(47.3±6.5)分、(42.7±5.5)分和(38.6±7.8)分增加到术后的(92.4±4.1)分、(88.2±4.7)分和(83.9±6.6)分,与术前比较差异有统计学意义(P<0.05)。结论对成人DDH按照Crowe分型采用不同方法行全髋关节置换,是一种可靠而有效的方法。充分的软组织松解、重建髋臼和股骨近端的结构以及正确选择假体是手术成功的关键。

Total hip arthroplasty in the treatment of developmental dysplasia of hip

Objective To evaluate the efficacy of total hip arthroplasty(THA) in patients with developmental dysplasia of hip(DDH).Methods Forty-eight cases(56 hips) with osteoarthritis secondary to DDH were treated with THA.According to the classification of Crowe,24 hips were in class Ⅰ,19 in classⅡand 13 in class Ⅲ/Ⅳ.Before operation,the morphological changes of acetabula and femurs were evaluated with helical CT.In addition to the standard procedure of THA with 35 patients(40 hips),the method of structural bone autografting for restoring normal level of rotating center of acetabular hip in 6 patients(8 hips),placement of the cup medially in 5 cases(6 hips)and placement of the cup higher in the ilium in 2 cases(2 hips)was carried out.Results After the follow-up of 3~96 months,there was no prosthesis loosening and the hip function was good.No complications were found with infection and dislocation and nerve palsy.The Harris hip score in class Ⅰ,Ⅱand Ⅲ/Ⅳ were from 47.3±6.5,42.7±5.5 and 38.6±7.8 preoperatively to 92.4±4.1,88.2±4.7 and 83.9±6.6 postoperatively,respectively.There was significant difference between them(P<0.05).Conclusions THA is a feasible method to treat osteoarthritis secondary to DDH using different methods according to classification of Crowe.Complete soft tissue release,reconstruction of acetabulum and femur,and proper prosthesis selection are essential.