CAJ | 학술논문

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 dyspla-sia 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1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1.1 cm(0～2.2 cm).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.
목적 탐토전관관절치환술치료성인Crowe Ⅳ형관관절발육불량(developmental dyspla-sia of the hip,DDH)적방법병평개기료효.방법 1997년10월지2009년1월,응용전관관절치환술치료Crowe Ⅳ형DDH환자15례20관,기중5례쌍측、10례단측.18관채용Secur-Fit고골가체,2관채용Corail고골가체.전자하사행절골6관,관구저마천5관,균행고골두식골.결과 15례중조기사망1례(쌍관),실방2례(2관),여12례16관획득평균44.2개월(5～92개월)수방.술후발생출혈성휴극1례,지방전새1례,술후탈위2례,고골상단골렬2례.전자하사행절골6관중,1관실수방,2관분별우술후18화23개월수방시잉가견골절선,하지행주무이상,기여3관골유합.관구저식골5관,제1관실방외,기여균획득유합.술후X선편현시관구가체균위우진구내,완전골성복개,무관구가체송동.술후쌍하지장도차평균1.1 cm(0～2.2 cm).말차수방Harris평분유술전평균(24.7±5.7)분(15～32분)제고지말차수방(85.6±5.6)분(80～94분),차이유통계학의의.결론 대Crowe Ⅳ형DDH환자행전관관절치환술시,량호적진구폭로、가심관구、고골단축、사행절골급사용Secur-Fit가체능제고전관관절치환술적치료효과.
Objective To develop the techniques in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH) and assess the clinical results. Methods From October 1997 to Janurary 2009, 15 patients (20 hips) with Crowe type Ⅳ DDH underwent THA, including 5 patients with bi-lateral hip involved, 10 patients with unilateral. 18 hips were treated with Secur-Fit prosthesis while 2 hips were treated with Corail prosthesis. 6 hips underwent oblique subtrochanteric shortening osteotomy. 5 ac-etabulums were reaming through and were grafted with femoral head. Postoperative clinical and radiological results were evaluated. Results 2 patients lost of follow-up. 12 patients (16 hips) were followed up for the average 44.2 (5-92) months. There were 1 patient with bilateral THA died from hemorrhagic shock and MOF 1 week after operation, 1 patient with fat embolism survived, 2 cases with dislocation, 2 cases with femoral fracture. Among the 6 cases with osteotomy, 1 lost of follow up, 2 could walk freely with the visible fracture lines at 18 and 23 months postoperatively, 3 got union. Among the 5 cases with acetabular graft with femoral head, 1 lost of follow up, 4 were observed with union. The main Harris score was promoted from 24.7±5.7 preoperatively to 85.6±5.6 postoperatively (t=27.3, P=0.000). Conclusion For the complex DDH, this paper presents the trick to expose the true acetabulum, deepen acetabulum, femoral shortening, oblique osteotomy,using of the Scour-Fit prosthesis. THA associated with these techniques can effectively improve the outcomes of Crowe type Ⅳ DDH.