中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2010年
2期
159-164
,共6页
宋立明%张铁良%毕晓扬%任凯晶
宋立明%張鐵良%畢曉颺%任凱晶
송립명%장철량%필효양%임개정
关节成形术%置换%髋%髋脱位%先天性%骨关节炎%髋
關節成形術%置換%髖%髖脫位%先天性%骨關節炎%髖
관절성형술%치환%관%관탈위%선천성%골관절염%관
Arthroplasty%replacement%hip%Hip dislocation%congenital%Osteoarthritis%hip
目的 评价初次全髋关节置换术治疗伴有晚期髋关节病变的髋关节发育不良患者的临床效果,探讨其技术可行性及操作要点.方法 回顾性分析2002年3月至2008年6月因严重髋关节发育不良而行初次全髋关节置换术的35例患者的临床和影像学资料.男11例11髋,女24例28髋;平均年龄(52±6.7)岁.CroweⅢ型27例31髋,Ⅳ型8例8髋.术前平均Harris评分(42.5±5.3)分.均采用非骨水泥型全髋关节假体.结果 全部患者随访1～7年,平均46个月.末次随访时Harris评分(86.3±3.4)分,与术前比较差异有统计学意义.优33髋,良5髋,可1髋,优良率97.4%.随访期间未发现髋臼假体周围透光带及松动表现.2例出现术中髋臼骨折,根据骨折稳定性,经多枚螺钉或结构性植骨后卧床6周愈合.3例出现下肢深静脉血栓,经溶栓治疗后血栓消失.5例6髋出现Brooker Ⅰ级或Ⅱ级异位骨化.1例于术后1年因外伤发生假体远端骨折.结论 对伴有晚期髋关节病变的严重髋关节发育不良患者行初次全髋关节置换术时,术前应进行精确测量与评估,术中彻底松解软组织,正确处理髋臼和股骨,术后近期临床效果良好.
目的 評價初次全髖關節置換術治療伴有晚期髖關節病變的髖關節髮育不良患者的臨床效果,探討其技術可行性及操作要點.方法 迴顧性分析2002年3月至2008年6月因嚴重髖關節髮育不良而行初次全髖關節置換術的35例患者的臨床和影像學資料.男11例11髖,女24例28髖;平均年齡(52±6.7)歲.CroweⅢ型27例31髖,Ⅳ型8例8髖.術前平均Harris評分(42.5±5.3)分.均採用非骨水泥型全髖關節假體.結果 全部患者隨訪1～7年,平均46箇月.末次隨訪時Harris評分(86.3±3.4)分,與術前比較差異有統計學意義.優33髖,良5髖,可1髖,優良率97.4%.隨訪期間未髮現髖臼假體週圍透光帶及鬆動錶現.2例齣現術中髖臼骨摺,根據骨摺穩定性,經多枚螺釘或結構性植骨後臥床6週愈閤.3例齣現下肢深靜脈血栓,經溶栓治療後血栓消失.5例6髖齣現Brooker Ⅰ級或Ⅱ級異位骨化.1例于術後1年因外傷髮生假體遠耑骨摺.結論 對伴有晚期髖關節病變的嚴重髖關節髮育不良患者行初次全髖關節置換術時,術前應進行精確測量與評估,術中徹底鬆解軟組織,正確處理髖臼和股骨,術後近期臨床效果良好.
목적 평개초차전관관절치환술치료반유만기관관절병변적관관절발육불량환자적림상효과,탐토기기술가행성급조작요점.방법 회고성분석2002년3월지2008년6월인엄중관관절발육불량이행초차전관관절치환술적35례환자적림상화영상학자료.남11례11관,녀24례28관;평균년령(52±6.7)세.CroweⅢ형27례31관,Ⅳ형8례8관.술전평균Harris평분(42.5±5.3)분.균채용비골수니형전관관절가체.결과 전부환자수방1～7년,평균46개월.말차수방시Harris평분(86.3±3.4)분,여술전비교차이유통계학의의.우33관,량5관,가1관,우량솔97.4%.수방기간미발현관구가체주위투광대급송동표현.2례출현술중관구골절,근거골절은정성,경다매라정혹결구성식골후와상6주유합.3례출현하지심정맥혈전,경용전치료후혈전소실.5례6관출현Brooker Ⅰ급혹Ⅱ급이위골화.1례우술후1년인외상발생가체원단골절.결론 대반유만기관관절병변적엄중관관절발육불량환자행초차전관관절치환술시,술전응진행정학측량여평고,술중철저송해연조직,정학처리관구화고골,술후근기림상효과량호.
Objective To evaluate the clinical results of the primary total hip arthroplasty (THA) for treating severe developmental dysplasia of the hip (DDH) and to explore the practicality and operation points.Methods We investigated and analyzed the clinical and X-ray results of 35 severe DDH patients who re-ceived primary THA from March 2002 to June 2008, including 11 males (11 hips) and 24 females (28 hips),with the average age of 52±6.7 years (ranged 45-71 years). According to Crowe classification, 27 patients (31 hips) were classified as type Ⅲ and 8 patients (8 hips) as type Ⅳ. The mean Harris score was 42.5±5.3 pre-operatively. All the patients received non-cemented prosthesis. Results All patients were followed up for average 46 months (1-7 years). The mean Harris score was 86.3±3.4 points at the final follow-up, which had statistic significancy. Among these patients, 33 hips had excellent results, 5 hips had good results and 1 hip had fair results. The rate of excellent and good results was 97.4%. During the follow-up period, there was no radio-lucent line or prosthesis loosening. Two cases suffered acetabuiar fractures during surgery, and were treated with additional screws or structural bone-grafting according to the fracture stability. After 6 weeks,both fractures healed uneventfully. Three patients developed deep vein thrombosis (DVT) and after throm-bolytic therapy, the thrombus disappeared. Heterotopic ossification (Brooker type Ⅰ or type Ⅱ) were found in 5 patients (6 hips), and the rate of beterotopic ossification was 15.4%. One patient suffered femoral frac-ture at the level below the femoral prosthetic tip one year after THA due to injury. Conclusion For the se-vere DDH patients, it's neccesary to make precise measurement and accurate evaluation before primary THA, and do thorough soft tissue releasement during operation, fix the acetabular and femoral prostheses ac-cording to bone character and deal with intraoperative fractures properly. Thus good short-term clinical re-suits can be expected.
