摘要
目的 总结采用自体股骨头结构性植骨治疗髋关节发育不良继发关节炎的中期疗效及并发症.方法 回顾性分析2001年10月至2011年12月采用自体股骨头重建髋臼方法治疗36例髋关节发育不良患者资料,其中34例获得30个月以上的临床及影像学完整随访资料,男6例,女28例;年龄28～68岁,平均51岁;均为单侧手术,左侧16例,右侧18例.Crowe分型,Ⅱ型12例,Ⅲ型16例,Ⅳ型6例;所用假体除l例为混合型外,其余均为非骨水泥型.临床随访包括术前、术后Harris评分及各种并发症;影像学评估包括双侧髋关节正位（或骨盆正位）、患侧髋关节侧位X线片,以判断人工假体位置、植骨愈合情况.结果 34例患者均获得随访,随访时间31～153个月,平均64.1个月.术前Harris评分为23～56分,平均35.4分;末次随访时为82～95分,平均89分,其中优28例,良6例,优良率为100％.术后2～8个月,10例出现植骨块吸收.术后4例患者发生髋关节假体脱位,遂均采用闭合复位,其中1例于复位后2个月再次发生脱位,再次采用闭合复位后未再发生脱位;另3例均未再发生脱位.1例患者于术后3个月摔倒后出现假体周围骨折,行骨折切开复位钢板内固定术,1年随访时骨折已愈合,至末次随访时假体及内固定位置良好、骨折愈合良好,患髋功能良好.术后1年,1例患者因高血压颅内出血行保守治疗后关节置换侧偏瘫,关节失用.结论 自体股骨头重建髋臼治疗髋关节发育不良整体疗效满意,骨吸收是结构性植骨的一个自然过程,关节脱位是髋关节发育不良全髋置换术后的最常见并发症.
Objective To evaluate the midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip.Methods From October 2001 to December 2011,36 patients （36 hips） with developmental dysplasia of the hip were treated by total hip arthroplasty with autologous femoral head grafting,of which 34 cases were followed up for at least 30 months.There were 6 males and 28 females.16 patients were involved in the left hip and 18 in right hip.The average age at the operation was 51 years （range,28-68 years）.According to Crowe classification for developmental dysplasia of the hip,12 were type Ⅱ,16 type Ⅲ,and 6 type Ⅳ.Cementless prostheses were used for all,but one patient,who received a hybrid prosthesis.Clinical outcomes were evaluated according to Harris score and complications.Components migration,periprosthetic bone changes,the polyethylene wear rate were measured radiologically.Components position and bone healing were assessed in the anteriorposterior and lateral X-ray of the hips.Results Thirty-four patients （34 hips） were followed up for an average duration of 64.1 months （range,31-153 months）.The average Harris score was 35.4 （range,23-56） preoperatively,and was 89 （range,82-95） at the latest follow-up.Twenty-eight were classified as excellent,and 6 were good,and the excellent and good rate was 100%.10 cases presented with bone absorption 2-8 months postoperatively.Four patients suffered from dislocation after surgery.All the cases were treated successfully with close reduction,except one with redislocation.Close reduction was performed for this case,and no dislocation occurred again.One patient had periprosthetic fracture due to a fall and open reduction and plate fixation was performed.The fracture was healed at 1 year follow-up,with good position of the implants.Another patient had hypertensive intracerebral hemorrhage 1 year after the surgery,who was treated by conservative treatment and had hemiplegia and apraxia of the surgical hip.Concl
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2015年第4期401-406,共6页
Chinese Journal of Orthopaedics
关键词
髋脱位
先天性
股骨头
移植
自体
骨移植
Hip dislocation,congenital
Femur head
Transplantation,autologous
Bone transplantation
