摘要
目的 研究CroweⅣ型髋关节发育不良（DDH）患者行人工全髋关节置换时采用转子间截骨与转子下截骨治疗的疗效及安全性。方法 回顾性分析1999年5月—2013年12月期间收治的33例（37髋）CroweⅣ型DDH患者，年龄17～67岁，平均35．9岁。在行人工全髋关节置换术中时采取了不同的截骨方式，其中28例（30髋）接受了改进的转子间截骨、5例（7髋）采用了转子下截骨。两组患者均用改良的Merled Aubigné和Postel部分评分进行效果评定，术前平均分别为9．4分、9．7分，下肢长度差异平均分别为44．7mm、57．5mm，收集评估临床及影像学检查数据。结果 平均随访时间为83．6个月，术后转子间截骨与转子下截骨患者下肢的平均长度差异分别是9．2mm、9．4mm，末次随访Meded Aubigné评分平均分别为15．9分、15．8分。转子间截骨组患者中有2例术后出现坐骨神经麻痹，但是6个月内症状完全缓解。末次随访中转子间截骨组有2例Trendelenburg征阳性。在随访期内均无假体翻修的患者。各组手术前后Meded Aubigné和Postel部分评分差异均有统计学意义（P值均〈0．05），两组间统计学差异均无统计学意义（P〉0．05）。结论 人工全髋关节置换术中股骨缩短治疗CroweⅣ型髋关节发育不良时，无论是转子问截骨还是转子下截骨均安全有效。
Objective To evaluate the efficacy and safety of lesser trochanteric osteotomy and subtrochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of Crowe IV developmental dysplasia of the hip （DDH）. Methods From May 1999 to December 2013, 33 cases （37 hips） with Crowe Ⅳ DDH underwent different methods for femoral shortening with femoral resection in total hip replacement. Twenty-eight patients （30 hips） underwent progressive femoral shortening at the level of lesser trochanteric, 5 patients （7 hips ） accepted subtrochanteric shortening osteotomy, 29 cases were unilateral hip and bilateral hip was involved in 4 cases in both packets with an range age of 17 - 67 years （averaged 35.9 replacement years）. A modified Merled Aubigné scale was used in both team , and the score was 9.4,9.7 preoperatively, and the average leg length discrepancy was 44.7 mm, 57.5 mm. Clinical and radiographical results were collected and evaluated. A regular follow-up was done after surgery. Results The mean follow-up period was 83.6 months, the average leg length discrepancy of lesser trochanteric osteotomy and subtrochanteric shortening osteotomy were 9.2mm, 9.4 mm postoperatively, and Merled Aubigné scale was improved to 15.9 and 15.8. There were two hips with sciatic nerve palsy in lesser trochanteric osteotomy group after surgery. However, resolved completely in six months, and two cases trendelenburg sign was still positive in this group at the final follow-up . No revision of acetabular and femoral components was required by the final follow-up. Compared with pre-and post-operative in each group, the Merled Aubigné scale and Harris score showed significant difference （ all P values 〈 0.05 ）, no difference existed between two groups （ all P values 〉 0.05 ）. Conclusions Transtrochanteric osteotomy and subtrochanteric shortening osteotomy for femoral shortening in total hip arthroplasty in treatment of Crowe Ⅳ DDH are safe and effective.
出处
《中华解剖与临床杂志》
2014年第6期478-482,共5页
Chinese Journal of Anatomy and Clinics
基金
江苏省临床科技基金（BL2012002）
江苏省自然科技基金（BK2012776）
关键词
髋脱位
先天性
关节成形术
置换
髋
转子间截骨
转子下截骨
Hip dislocation, congenital
Arthoplasty, replacement, hip
Transtrochanteric osteotomy
Subtrochanteric osteotomy
