中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2010年
2期
148-152
,共5页
赵秀祥%于建华%卜延民%郑得志
趙秀祥%于建華%蔔延民%鄭得誌
조수상%우건화%복연민%정득지
髋脱位%先天性%关节成形术%置换%髋%截骨术
髖脫位%先天性%關節成形術%置換%髖%截骨術
관탈위%선천성%관절성형술%치환%관%절골술
Hip dislocation%congenital%Arthroplasty%replacement%hip%Osteotomy
目的 探讨股骨转子下横行短缩截骨在Crowe Ⅳ型髋关节发育不良全髋关节置换中的作用.方法 2001年2月至2007年2月对12例Crowe Ⅳ型髋关节发育不良患者行股骨转子下横行短缩截骨的全髋关节置换.男3例,女9例;年龄45～65岁,平均54岁.左髋5例,右髋6例,双髋1例.术前患肢短缩1.8～5.0cm,平均3.5 cm.4例中度跛行,8例重度跛行.于术后3、6、12个月,以后每年随访一次.摄X线片观察截骨愈合、假体下沉及松动情况.观察患者跛行情况,髋关节功能评价采用Harris评分.结果 全部患者随访2～7年,平均3.0年.截骨长度1.5～4.2 cm,平均2.2 cm.无坐骨神经损伤.截骨均愈合,愈合时间3～15个月,平均5.3个月.末次随访时3例轻度跛行,4例中度跛行,无重度跛行患者.髋关节Harris评分从术前平均36分(30～60分)提高到末次随访平均83分(75～95分).2髋分别于术后5年和7年发生股骨假体下沉,下沉高度分别为3 mm和6 mm.无假体松动及术后感染.结论 对Crowe Ⅳ型髋关节发育不良患者实施全髋关节置换术时行转子下横行短缩截骨,为真臼的暴露、臼杯的准确安装、增加股骨假体柄直径、矫正股骨假体柄前倾角创造了条件,可避免神经损伤.
目的 探討股骨轉子下橫行短縮截骨在Crowe Ⅳ型髖關節髮育不良全髖關節置換中的作用.方法 2001年2月至2007年2月對12例Crowe Ⅳ型髖關節髮育不良患者行股骨轉子下橫行短縮截骨的全髖關節置換.男3例,女9例;年齡45～65歲,平均54歲.左髖5例,右髖6例,雙髖1例.術前患肢短縮1.8～5.0cm,平均3.5 cm.4例中度跛行,8例重度跛行.于術後3、6、12箇月,以後每年隨訪一次.攝X線片觀察截骨愈閤、假體下沉及鬆動情況.觀察患者跛行情況,髖關節功能評價採用Harris評分.結果 全部患者隨訪2～7年,平均3.0年.截骨長度1.5～4.2 cm,平均2.2 cm.無坐骨神經損傷.截骨均愈閤,愈閤時間3～15箇月,平均5.3箇月.末次隨訪時3例輕度跛行,4例中度跛行,無重度跛行患者.髖關節Harris評分從術前平均36分(30～60分)提高到末次隨訪平均83分(75～95分).2髖分彆于術後5年和7年髮生股骨假體下沉,下沉高度分彆為3 mm和6 mm.無假體鬆動及術後感染.結論 對Crowe Ⅳ型髖關節髮育不良患者實施全髖關節置換術時行轉子下橫行短縮截骨,為真臼的暴露、臼杯的準確安裝、增加股骨假體柄直徑、矯正股骨假體柄前傾角創造瞭條件,可避免神經損傷.
목적 탐토고골전자하횡행단축절골재Crowe Ⅳ형관관절발육불량전관관절치환중적작용.방법 2001년2월지2007년2월대12례Crowe Ⅳ형관관절발육불량환자행고골전자하횡행단축절골적전관관절치환.남3례,녀9례;년령45～65세,평균54세.좌관5례,우관6례,쌍관1례.술전환지단축1.8～5.0cm,평균3.5 cm.4례중도파행,8례중도파행.우술후3、6、12개월,이후매년수방일차.섭X선편관찰절골유합、가체하침급송동정황.관찰환자파행정황,관관절공능평개채용Harris평분.결과 전부환자수방2～7년,평균3.0년.절골장도1.5～4.2 cm,평균2.2 cm.무좌골신경손상.절골균유합,유합시간3～15개월,평균5.3개월.말차수방시3례경도파행,4례중도파행,무중도파행환자.관관절Harris평분종술전평균36분(30～60분)제고도말차수방평균83분(75～95분).2관분별우술후5년화7년발생고골가체하침,하침고도분별위3 mm화6 mm.무가체송동급술후감염.결론 대Crowe Ⅳ형관관절발육불량환자실시전관관절치환술시행전자하횡행단축절골,위진구적폭로、구배적준학안장、증가고골가체병직경、교정고골가체병전경각창조료조건,가피면신경손상.
Objective To observe the effect of transveme subtrochanteric femoral shortening osteoto-my in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods From February 2001 to February 2007, 12 patients with Crowe type Ⅳ DDH were performed primary THA combined with transverse subtrochanteric femoral shortening osteotomy. There were 3 males and 9 females,with the average age of 54 years(ranged, 45-65 years). Five hips were left, 7 hips were right and both sides for 1 patient. The average leg length discrepancy were 3.5 cm (ranged, 1.8-5.0 cm). There were 4 patients with moderate limp and 8 patients with servere limp. Clinical and radiographic data were retrospectively re-viewed at the 3rd, 6th, 12th month after operation, and then it was done every year. The bone union, pros-thesis subsidence, leg limp and the hip Harris score were evaluated. Results The average follow-up was 3.0 years (2-7 years), and the average length of shortening osteotomy was 2.2 cm (1.5-4.2 cm). No nerve injury and nonunion occurred. At ther final follow-up, there were 3 cases of mild limp, 4 cases of moderate limp and no severe ones. The mean Harris score improved from 36 (30-60) before operation to 83 (75-95). The mean union time was 5.3 months after operation (3-24 months after operation). The prosthesis subsidences were found in 1 case at the 5th year after operation and 1 case at the 7th year after operation, and with the subsiding height of 3 mm and 6 mm respectively. No loosening and infection were found in all patients.Conclusion Transverse subtrochanteric shortening osteotomy for Crowe type Ⅳ DDH is easy to performe. It can help to expose the true actabulum and fix the socket precisely, and also facilitate to improve the diame-ter of the prosthesis, correct the anterversion, and prevent nerve injury.
