CAJ | 학술논문

目的分析转子下截骨全髋关节置换治疗Crowe Ⅳ型髋关节发育不良的围手术期并发症.方法 2002年6月至2009年8月,因Crowe Ⅳ型髋关节发育不良接受股骨转子下截骨全髋关节置换术35例42髋,男11例,女24例;年龄28～68岁,平均(47.4±9.61)岁.回顾性分析围手术期并发症的类型、发生率及导致并发症的相关因素.结果全部病例随访3～84个月,平均24.3个月.术前Harris评分平均(60.42±14.41)分,末次随访平均(81.58±26.96)分,差异有统计学意义(t=-2.3545,P=0.0382).共18髋发生并发症21髋次,并发症发生率42.9%(18/42);其中20髋次出现于2008年以前的病例,并发症发生率65.4%(17/26).包括骨折11髋(26.2%),血管并发症2髋(4.8%),神经并发症4髋(9.5%),截骨不愈合2髋(4.8%),术后脱位及假体松动各1髋(2.4%).行预防性钢丝环扎的10髋均未出现骨折,未行预防性环扎32髋中11髋出现骨折,两组差异有统计学意义(χ~2=4.657,P=0.031).Hartofilakidis C1型髋关节发育不良患者围手术期并发症发生率为55.0%(11/20),C2型为23.1%(3/13),差异无统计学意义(χ~2=3.287,P=0.070).结论对Crowe Ⅳ型髋关节发育不良行转子下截骨全髋关节置换并发症发生率高.周密的术前设计和规范的手术操作可减少围手术期并发症的发生.
목적 분석전자하절골전관관절치환치료Crowe Ⅳ형관관절발육불량적위수술기병발증.방법 2002년6월지2009년8월,인Crowe Ⅳ형관관절발육불량접수고골전자하절골전관관절치환술35례42관,남11례,녀24례;년령28～68세,평균(47.4±9.61)세.회고성분석위수술기병발증적류형、발생솔급도치병발증적상관인소.결과 전부병례수방3～84개월,평균24.3개월.술전Harris평분평균(60.42±14.41)분,말차수방평균(81.58±26.96)분,차이유통계학의의(t=-2.3545,P=0.0382).공18관발생병발증21관차,병발증발생솔42.9%(18/42);기중20관차출현우2008년이전적병례,병발증발생솔65.4%(17/26).포괄골절11관(26.2%),혈관병발증2관(4.8%),신경병발증4관(9.5%),절골불유합2관(4.8%),술후탈위급가체송동각1관(2.4%).행예방성강사배찰적10관균미출현골절,미행예방성배찰32관중11관출현골절,량조차이유통계학의의(χ~2=4.657,P=0.031).Hartofilakidis C1형관관절발육불량환자위수술기병발증발생솔위55.0%(11/20),C2형위23.1%(3/13),차이무통계학의의(χ~2=3.287,P=0.070).결론 대Crowe Ⅳ형관관절발육불량행전자하절골전관관절치환병발증발생솔고.주밀적술전설계화규범적수술조작가감소위수술기병발증적발생.
Objective To evaluate the complications of total hip arthroplasty (THA) with a shortening subtrochanteric osteotomy in a group of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH), and to refine surgical techniques to decrease the incidence of the complications. Methods From Jun. 2002 to Aug. 2009, 35 patients (42 hips) with Crowe type Ⅳ DDH underwent DDH, including 24 females and 11 males, with the mean age of (47.4±9.61) years. The results and complications were evaluated retrospectively. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. Results The mean Harris hip score increased from 60.42±14.41 points preoperatively to 81.58±26.96 points at the time of final follow-up (P=0.0382). Eighteen of the 42 hips (42.9%) had a peri-operative complication. Eleven perioperative fractures happened. Two hips were followed by nonunion. Four nerve injuries and two vascular injuries occurred. One hip dislocated postoperatively. All components were well-fixed at the time of the last radiographic follow-up except one femur stem loosened. Avoidance of over or under reaming, appropriating osteotomy level and prophylactic cerclage wiring were associated with low complication rate. Conclusion Subtrochanteric osteotomy, performed in THA for osteoarthritis secondary to Crowe type Ⅳ DDH, is a highly complicated surgical procedure. Appropriate prosthesis selection and meticulous surgical techniques is mandatory and efficient to decrease the complication rates.