摘要
目的探讨初次人工全髋关节置换术(total hip arthroplasty,THA)治疗CroweⅣ型发育性髋关节发育不良(development dysplasia of the hip,DDH)的远期疗效。方法回顾性分析2002年1月—2008年8月因CrownⅣ型DDH行初次THA且随访达13年的患者临床资料,共42例(45髋)符合选择标准纳入研究。男13例,女29例;年龄18~65岁,平均43.5岁。单髋39例,双髋3例。术前髋关节Harris评分为(38.3±10.7)分。单侧置换患者双下肢长度差值为(50.52±24.51)mm。术中19髋联合股骨转子下短缩截骨术,截骨长度为15~35 mm,平均25 mm。记录患者髋关节Harris评分、主观满意度、假体生存率、并发症发生情况,以及相关影像学观测指标。结果患者均获随访,随访时间13.0~19.6年,平均15.0年。术后发生股神经损伤症状1髋、关节脱位2髋、假体周围骨折1髋、假体周围关节感染1髋;无其他并发症发生。末次随访时,髋关节Harris评分为(82.1±9.3)分,较术前改善(t=−21.885,P=0.000)。患者自评满意度:非常不满意3髋、较不满意1髋、一般4髋、较满意17髋、非常满意20髋。X线片复查显示,术后即刻患侧大转子高度为3.01~51.60 mm,平均23.22 mm;大转子下移量为3.95~98.06 mm,平均48.20 mm;患侧肢体延长长度为3.95~61.63 mm,平均34.92 mm;单侧置换患者双下肢长度差值为(12.61±8.56)mm,较术前缩短(t=11.721,P=0.000);患侧臼杯旋转中心与泪滴连线垂直距离为(14.65±6.16)mm,与健侧(15.60±4.99)mm比较,差异无统计学意义(t=−0.644,P=0.525);水平距离为(22.21±5.14)mm,与健侧(34.48±5.63)mm比较,差异有统计学意义(t=−12.973,P=0.000)。除1髋截骨不愈合外,其他患者截骨均愈合良好。随访期间所有假体近端多孔涂层部分均获得了稳定骨长入,无连续放射性透亮线或者放射性硬化线。以任何再手术、假体无菌性松动为终点事件,假体生存率分别为88.64%[95%CI(63.73%,96.82%)]、89.19%[95%CI(65.61%,96.94%)]。结论CroweⅣ型DDH患
Objective To investigate the long-term effectiveness of primary total hip arthroplasty(THA)in treatment of Crowe typeⅣdevelopmental dysplasia of the hip(DDH).Methods A clinical data of Crowe typeⅣDDH patients treated with primary THA between January 2002 and August 2008 and followed up more than 13 years was retrospectively analyzed.Forty-two patients(45 hips)met the selection criteria and were enrolled in this study.There were 13 males and 29 females with an average age of 43.5 years(range,18-65 years).There were 39 patients of unilateral hip and 3 of bilateral hips.The preoperative Harris score was 38.3±10.7 and leg length discrepancy of the patients treated with unilateral THA was(50.52±24.51)mm.During operation,19 hips underwent subtrochanteric shortening osteotomy,with an average length of 25 mm(range,15-35 mm).The Harris score,subjective satisfaction,prosthesis survival rate,complications,and related imaging indicators were summarized.Results All patients were followed up 13.0-19.6 years(mean,15.0 years).The complications included 1 hip of femoral nerve palsy,2 hips of dislocation,1 hip of periprosthetic fracture,1 hip of periprosthetic joint infection.At last follow-up,the Harris score was 82.1±9.3,which significantly improved when compared with preoperative one(t=−21.885,P=0.000).The subjective satisfaction was evaluated as very dissatisfactory in 3 hips,dissatisfactory in 1 hip,generally in 4 hips,satisfactory in 17 hips,and very satisfactory in 20 hips.X-ray films showed that the height of the greater trochanter of affected side was 3.01-51.60 mm(mean,23.22 mm);the descending distance of greater trochanter was 3.95-98.06 mm(mean,48.20 mm);the affected limb lengthened 3.95-61.63 mm(mean,34.92 mm);the leg length discrepancy of patients treated with unilateral THA was(12.61±8.56)mm,which was significantly shorter than that before operation(t=11.721,P=0.000).The vertical distance between the center of rotation of the affected side and the teardrop line was(14.65±6.16)mm,and the difference was not
作者
周一新
黄勇
何睿哲
褚亚明
顾建明
李桦
马宁
ZHOU Yixin;HUANG Yong;HE Ruizhe;CHU Yaming;GU Jianming;LI Hua;MA Ning(Department of Orthopedics,Beijing Jishuitan Hospital(Fourth Clinical College of Peking University),Beijing,100035,P.R.China;Senior Department of Orthopedics,General Hospital of Chinese PLA,Beijing,100853,P.R.China;National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Beijing,100853,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2021年第12期1531-1536,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
北京积水潭医院横向课题
北京市医院管理中心科研培育计划项目(PX2020019)。
