摘要
[目的]探讨全髋关节置换术术中股骨转子下短缩旋转截骨在髋关节发育不良IV型患者手术治疗的临床应用价值和改良研究。[方法]对2006年8月-2011年8月5年间接受全髋关节置换术的38例（52髋）髋关节发育不良Ⅳ型患者术中实施股骨转子下2．5cm处短缩旋转截骨，女27例，男11例，年龄28—52岁，平均34．6岁，均为Crowe分型Ⅳ型患者，术前x线片测量股骨前倾平均（48．7±12．2）°，单侧患者，下肢长度较健侧短缩（4．5±1．2）cm，术前Harris评分（37．3±9．6），VAS评分（5．6±1．6）。均采用髋关节后外侧入路，常规清理骨赘及增生纤维组织，松解关节囊，完整保护臀中肌，髋臼侧寻找真臼内常规植骨磨臼，植入生物型髋臼假体，股骨试模内支撑下线锯横行截骨（截骨长度2．2～4．8cm），短缩并纠正前倾角至15°～20°后，断端采用6孔AO单皮质锁定钢板（LCP）外侧固定，再置入Zweymuller—SL喷涂生物股骨柄，术后6周拄双拐下地锻炼，术后12周弃拐行走。[结果]平均随访时间5—32个月，平均19个月，手术时间（87±22）min，术中出血量为（106±15）ml，术后引流量为（218±42）ml，均未出现坐骨神经损伤表现，住院期间无伤口感染及深部感染。至末次随访，Harris评分（81．6±5．2）分，VAS疼痛评分（1．0±0．2）分，二者较术前改善，差异有统计学意义（P〈0．05）。X线片测量双下肢长度差异（0．12±0．01）cm，CT测量股骨前倾角（16．8±2．1）°，二者较术前差异有统计学意义（P〈0．05）。[结论]全髋关节置换术术中股骨转子下截骨技术是治疗髋关节发育不良（Ⅵ型）的一种有效方法。
[ Objective] To investigate the clinical value of femoral subtrochanteric shortening and rotational osteotomy in the treatment of patients with type IV developmental dysplasia of the hip （DDH）, and to conduct a modified study. [ Methods] A total of 38 patients with type IV DDH （including 52 hips） who underwent total hip replacement （THR） from August 2006 to August 2011 were enrolled, and they underwent shortening and rotational osteotomy at 2. 5 cm below the femoral trochanter. There were 27 female patients and 11 male patients, aged 28 - 52 years （ mean 34. 6 years） . They all had Crowe type IV DDH. The mean femoral neck anteversion measured by preoperative X - ray was （48. 7± 12. 2）°. In unilateral patients, the affected lower limb was （4. 5 ± 1.2） cm shorter than the healthy limb. The patients had a mean preoperative Harris score of （37. 3 ±9.6） and a mean Visual Analogue Scale （VAS） score of （5.6 ± 1.6） . The posterulateral hip approach was applied for all patients. Osteophyte and hyperplastic fibrous tissue were cleared, the joint capsule was loosened, gluteus medius was completely preserved, the true acetabulum was located from the acetabular side to perform bone grafting and acetabulum grinding, cement- less aeetabular prosthesis was placed, and then femoral shortening and rotational osteotomy was performed with a shortening length of 2. 2 - 4. 8 cm. After the anteversion angle was adjusted to 15° - 20°, the broken end was fixated with 6 - hole AO locking plate, and the cementless femoral stem with Zweymuller - SL coating was implanted. The patients started to use crutches at 6 weeks after surgery, and walked on the ground by themselves at 12 weeks after surgery. [ Results ] The follow - up time ranged from 5 to 32 months （ mean 19 months） . The mean time of operation was （87 ± 22） min, the mean intraoperative blood loss was （ 106 ± 15 ） ml, and the mean volume of postoperative drainage was （218 ±42） ml. No patient experienced injury of the sci
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第17期1561-1565,共5页
Orthopedic Journal of China
基金
河南省科技攻关项目"现实与虚拟互动"技术在人工髋关节置换术的应用与研究
河南省重大科技攻关项目"生物型个体化髋臼杯的3D打印技术及在复杂髋关节置换中的应用研究"支持项目
关键词
发育性髋关节脱位
THR
股骨截骨
developmental dysplasia of the hip, total hip replacement, femoral osteotomy
