摘要
目的:比较非截骨和转子下截骨两种人工全髋关节置换术(total hip arthroplasty,THA)治疗成人CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)的临床疗效。方法:应用THA治疗35例单侧CroweⅣ型DDH患者,其中15例术中采用非截骨,20例采用股骨转子下截骨。两组患者性别、年龄、身体质量指数、侧别差异均无统计学意义(P>0.05),记录并比较两组手术时间、出血量、住院时间、术前及术后双下肢长度差、髋关节Harris评分。结果:35例患者获得随访,时间12~48个月,随访期间无髋关节感染、假体松动发生。非截骨组术后1例出现坐骨神经牵拉损伤、1例股神经皮神经分支损伤,3个月后均自行恢复。转子下截骨组术后1例出现髋关节脱位,给予闭合复位后无再次脱位发生,3例股骨近端劈裂骨折,给予钢丝固定治疗。两组手术时间、出血量与住院时间比较,差异均有统计学意义(P<0.05)。末次随访时两组Harris评分均较术前提高(P<0.05),两组间比较差异无统计学意义(P>0.05)。两组患者术后双下肢长度差比较,差异有统计学意义(P<0.05)。结论:非截骨THA治疗单侧CroweⅣ型DDH手术效果满意,该方法相对于股骨转子下截骨更简单。对于髋部软组织条件良好、患肢短缩>4 cm的CroweⅣ型DDH患者,可考虑采用非截骨全髋关节置换术。
Objective:To compare the clinical effects of total hip arthroplasty(THA) with non-osteotomy and subtrochanteric osteotomy in the treatment of Crowe type Ⅳ hip dysplasia (DDH) in adults. Methods:Data of 35 Crowe type Ⅳ DDH patients who underwent THA were analyzed retrospectively,the patients were divided into two groups:15 cases of non-osteotomy and 20 cases of subtrochanteric osteotomy. There was no significant difference in age,gender,body mass index between two groups (P>0.05). The operative time,bleeding volume,hospitalization duration,Harris hip score and the limb length discrepancy (LLD) were evaluated. Results:All of the patients were followed up for 12 to 48 months,no prosthesis loosening or infection occurred by the end of follow-up. In non-osteotomy group,1 case had occurred by sciatic nerve injury and 1 case developed cutaneous branch injury of the femoral nerve,both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in subtrochanteric osteotomy group,after closed reduction,dislocation did not recur;three cases had proximal femoral crack fractures and received steel plate fixation;no reoperation was needed. There was significant difference in operation duration,bleeding volume,and hospitalization days between two groups(P<0.05). The Harris score at last follow-up was significantly increased compared with preoperative score in two groups(P<0.05),but there was no significant difference between two groups(P>0.05). The postoperative discrepancy of bilateral lower limbs had significant difference(P<0.05). Conclusion:THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe Ⅳ developmental dysplasia of hip. Comparing with subtrochanteric osteotomy,the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening ≤4 cm and good tissue conditions,THA without femoral osteotomy may be considered.
作者
梅晓亮
张震祥
童健
朱伟
赵建宁
MEI Xiao-liang;ZHANG Zhen-xiang;TONG Jian;ZHU Wei;ZHAO Jian-ning(Department of Orthopaedics,General Hospital of Eastern Theater Command,PLA,Jinling Clinical College of Nanjing Medical University,Nanjing 210002,Jiangsu,China)
出处
《中国骨伤》
CAS
CSCD
2019年第9期792-797,共6页
China Journal of Orthopaedics and Traumatology
基金
国家自然科学基金(编号:81572111)~~
关键词
髋脱位
先天性
关节成形术
置换
髋
截骨术
Hip dislocation,congenital
Arthroplasty,replacement,hip
Osteotomy
