Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in thes...Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all ro展开更多
目的探讨全髋关节置换术治疗成人Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）的方法并评价其疗效。方法1997年10月至2009年1月，应用全髋关节置换术治疗Crowe Ⅳ型DDH患者15例20髋，其中5例双侧、10例单侧。1...目的探讨全髋关节置换术治疗成人Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）的方法并评价其疗效。方法1997年10月至2009年1月，应用全髋关节置换术治疗Crowe Ⅳ型DDH患者15例20髋，其中5例双侧、10例单侧。18髋采用Secur—Fit股骨假体，2髋采用Corail股骨假体。转子下斜行截骨6髋，髋臼底磨穿5髋，均行股骨头植骨。结果15例中早期死亡l例（双髋），失访2例（2髋），余12例16髋获得平均44．2个月（5-92个月）随访。术后发生出血性休克1例，脂肪栓塞1例，术后脱位2例，股骨上端骨裂2例。转子下斜行截骨6髋中，1髋失随访，2髋分别于术后18和23个月随访时仍可见骨折线，下肢行走无异常，其余3髋骨愈合。髋臼底植骨5髋，除1髋失访外，其余均获得愈合。术后x线片显示髋臼假体均位于真臼内，完全骨性覆盖，无髋臼假体松动。术后双下肢长度差平均1．1cm（0-2．2cm）。末次随访Harris评分由术前平均（24．7±5．7）分（15-32分）提高至末次随访（85．6±5．6）分（80-94分），差异有统计学意义。结论对Crowe Ⅳ型DDH患者行全髋关节置换术时，良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用Secur—Fit假体能提高全髋关节置换术的治疗效果。展开更多
文摘Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty(THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance(especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques availablefor THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments(prefabricated), Custom made acetabular augments(3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique(cotyloplasty) with chisel, Medial protrusion technique(cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all ro
文摘目的探讨全髋关节置换术治疗成人Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）的方法并评价其疗效。方法1997年10月至2009年1月，应用全髋关节置换术治疗Crowe Ⅳ型DDH患者15例20髋，其中5例双侧、10例单侧。18髋采用Secur—Fit股骨假体，2髋采用Corail股骨假体。转子下斜行截骨6髋，髋臼底磨穿5髋，均行股骨头植骨。结果15例中早期死亡l例（双髋），失访2例（2髋），余12例16髋获得平均44．2个月（5-92个月）随访。术后发生出血性休克1例，脂肪栓塞1例，术后脱位2例，股骨上端骨裂2例。转子下斜行截骨6髋中，1髋失随访，2髋分别于术后18和23个月随访时仍可见骨折线，下肢行走无异常，其余3髋骨愈合。髋臼底植骨5髋，除1髋失访外，其余均获得愈合。术后x线片显示髋臼假体均位于真臼内，完全骨性覆盖，无髋臼假体松动。术后双下肢长度差平均1．1cm（0-2．2cm）。末次随访Harris评分由术前平均（24．7±5．7）分（15-32分）提高至末次随访（85．6±5．6）分（80-94分），差异有统计学意义。结论对Crowe Ⅳ型DDH患者行全髋关节置换术时，良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用Secur—Fit假体能提高全髋关节置换术的治疗效果。
