CAJ | 학술논문

目的总结CroweⅣ成人髋脱位采用股骨转子下叠加缩短截骨行全髋置换术的方法与疗效.方法 2000年1月至2003年12月,收治8例(11髋)CroweⅣ型成人髋脱位患者,男3例,女5例;年龄40～57岁,平均48岁;单髋5例,双髋3例;先天性发育不良7例,陈旧性髋关节结核1例.假体臼杯为金属杯+聚乙烯内衬设计,其中Duraloc (Depuy,Warsaw,USA)8髋,Pressfit SⅡ(LINK,Germany)3髋.股骨柄假体采用AML(Depuy,Warsaw,USA)4髋,Summit(Depuy,Warsaw,USA)4髋,Ribbed(LINK,Germany)3髋.假体均采用生物学固定.手术均采用股骨转子下叠加缩短截骨,并附加断端"V"形截骨,其中6髋因最小号股骨柄假体置入困难,而附加股骨劈开成形术.结果无一例发生感染、脱位等并发症,无一例行臀大肌或臀中、小肌等短肌松解.转子下平均缩短截骨长度为4.5 cm(4～6 cm),无一例因截骨过短,导致股骨头假体复位困难或坐骨神经牵伸伤;也无一例因截骨过长,导致股骨头假体松弛性脱位.术后X线片示臼杯均位于真臼区,股骨柄假体的初始固定均优良,截骨断端在3～6个月后均骨性愈合.测量显示患肢平均延长3 cm(2.5～3.5 cm).随访3～7年,髋关节Harris评分从术前的25～32分改善至1年后的90～98分.无一髋假体显示有X线松动和邻近骨溶解.结论股骨转子下叠加缩短截骨术可用于CroweⅣ型成人髋脱位的全髋置换术治疗.
목적 총결CroweⅣ성인관탈위채용고골전자하첩가축단절골행전관치환술적방법여료효.방법 2000년1월지2003년12월,수치8례(11관)CroweⅣ형성인관탈위환자,남3례,녀5례;년령40～57세,평균48세;단관5례,쌍관3례;선천성발육불량7례,진구성관관절결핵1례.가체구배위금속배+취을희내츤설계,기중Duraloc (Depuy,Warsaw,USA)8관,Pressfit SⅡ(LINK,Germany)3관.고골병가체채용AML(Depuy,Warsaw,USA)4관,Summit(Depuy,Warsaw,USA)4관,Ribbed(LINK,Germany)3관.가체균채용생물학고정.수술균채용고골전자하첩가축단절골,병부가단단"V"형절골,기중6관인최소호고골병가체치입곤난,이부가고골벽개성형술.결과 무일례발생감염、탈위등병발증,무일례행둔대기혹둔중、소기등단기송해.전자하평균축단절골장도위4.5 cm(4～6 cm),무일례인절골과단,도치고골두가체복위곤난혹좌골신경견신상;야무일례인절골과장,도치고골두가체송이성탈위.술후X선편시구배균위우진구구,고골병가체적초시고정균우량,절골단단재3～6개월후균골성유합.측량현시환지평균연장3 cm(2.5～3.5 cm).수방3～7년,관관절Harris평분종술전적25～32분개선지1년후적90～98분.무일관가체현시유X선송동화린근골용해.결론 고골전자하첩가축단절골술가용우CroweⅣ형성인관탈위적전관치환술치료.
Objective To summarize the surgical technique and the clinical result of subtrochanteric shortening with overlapping femoral resection in primary total hip arthroplasty(THA)for Crowe type Ⅳadult dislocated hip (ADH).Methods From January 2000 to December 2003,11 primary hip arthroplasties were Derformed in Crowe Ⅳadult hip dislocation using a subtrochanteric shortening with overlapping femoral resection.There were 3 men and 5 women with an average age of 48 years (range 40-57 years).Subtrochanteric shortening with overlapping femoral resection and"V"shaped derotational osteotomy were performed for all cases without soft tissue release.The proximal femoral shaft splitting was used in 6 hips.Resnits The mean follow-up was 5 years (range 3-7 years).No operation was complicated by dislocation,or deep infection.Length of the reseeted subtrochanteric femour averaged 4.5 cm(4-6 cm).No hip reduction was encountered difficultly,and no nerve palsies and lax dislocation of the hip occurred.X-ray showed all acetabular cups were placed at the anatomical position,all osteotomies healed by 3-6 months.The Harris hip score improved from 25-32 to 90-98.Limb-length discrepancy was restored to an average of 3 cm after surgerv.No acetabular and femoral components need revision.No aseptic loosening or osteolysis was identified around the femoral or acetabulum components.Conclusion Subtrochanteric shortening osteotomy is a safe and predictable method of restoring the anatomic hip center in Crowe Ⅳ adult hip dislocation.