CAJ | 학술논문

背景：人工全髋关节置换为治疗髋关节发育性不良晚期患者的最佳选择，然而髋关节发育性不良的患者特别是CroweⅣ型因其髋关节解剖结构的显著异常，增加了手术难度且手术方法颇有争议。 　　目的：探讨人工全髋关节置换治疗CroweⅣ型成人髋关节发育性不良的疗效及髋臼重建与股骨侧处理的方法。 　　方法：纳入12例(14髋)Crowe Ⅳ型成人髋关节发育不良患者进行人工全髋关节置换，Harris 评分术前平均(35.0±6.8)分，髋臼侧采用小臼杯结合髋臼加深技术安置臼杯假体，股骨侧行转子下短缩截骨放置股骨假体，采用Harris评分评价置换后髋关节功能。 　　结果与结论：所有患者随访1-7年，平均4.6年，2例2髋发生置换过程中股骨大转子不全骨折，予钢丝固定。1例置换后出现坐骨神经刺激症状，1个月后恢复正常，无感染、假体松动及有明显临床表现的深静脉血栓形成等并发症。股骨侧截骨处均骨性愈合。置换后末次随访Harris评分平均为(84.0±7.0)分，置换后肢体延长4-6 cm，平均5 cm，短缩的肢体得到满意纠正。说明采用小臼杯、髋臼内陷技术、股骨短缩截骨对CroweⅣ型成人髋关节发育性不良患者行全髋关节置换能重建关节功能，恢复下肢长度，长期疗效有待于进一步观察。
배경：인공전관관절치환위치료관관절발육성불량만기환자적최가선택，연이관관절발육성불량적환자특별시CroweⅣ형인기관관절해부결구적현저이상，증가료수술난도차수술방법파유쟁의。 　　목적：탐토인공전관관절치환치료CroweⅣ형성인관관절발육성불량적료효급관구중건여고골측처리적방법。 　　방법：납입12례(14관)Crowe Ⅳ형성인관관절발육불량환자진행인공전관관절치환，Harris 평분술전평균(35.0±6.8)분，관구측채용소구배결합관구가심기술안치구배가체，고골측행전자하단축절골방치고골가체，채용Harris평분평개치환후관관절공능。 　　결과여결론：소유환자수방1-7년，평균4.6년，2례2관발생치환과정중고골대전자불전골절，여강사고정。1례치환후출현좌골신경자격증상，1개월후회복정상，무감염、가체송동급유명현림상표현적심정맥혈전형성등병발증。고골측절골처균골성유합。치환후말차수방Harris평분평균위(84.0±7.0)분，치환후지체연장4-6 cm，평균5 cm，단축적지체득도만의규정。설명채용소구배、관구내함기술、고골단축절골대CroweⅣ형성인관관절발육성불량환자행전관관절치환능중건관절공능，회복하지장도，장기료효유대우진일보관찰。
BACKGROUND:Total hip arthroplasty is an optimal choice for patients with late hip dysplasia. Crowe type IV developmental dysplasia of the hip increases the difficulty of the operation, and the surgery is controversial. OBJECTIVE:To evaluate the clinical effects of total hip arthroplasty on Crowe type IV developmental dysplasia of the hip and the method of reconstruction of acetabulum and the treatment of proximal femur. METHODS:A total of 12 patients (14 hips) with Crowe type IV developmental dysplasia of the hip underwent total hip arthroplasty. Preoperative Harris hip score was averagely (35.0±6.8) points. Al hips were treated with smal acetabular components combined with medial protrusion technique in acetabular reconstruction, as wel as subtrochanteric shortening osteotomy in femur. Joint function of hips was evaluated according to the Harris hip score. RESULTS AND CONCLUSION:Al patients were fol owed up with an average of 4.6 years (ranged 1 to 7 years). Two cases (two hips) suffered from infraction of greater trochanter of femur during replacement, and it was fixed with wire. There was complete sciatic nerve injury in one case, which partial y restored after conservative treatment for 1 month. No infection, prosthesis loosening, or deep venous thrombosis with obvious clinical manifestations was visible. Bone union was observed at the site undergoing osteotomy at the side of femur. After replacement, final fol ow-up showed that Harris hip score was averagely (84.0±7.0) points. The mean amount of postoperative leg lengthening was 5 cm (range 4-6 cm). Shortened limbs were corrected satisfactorily. These results suggested that total hip arthroplasty using smal acetabular component, medial protrusion, and femoral subtrochanteric shortening osteotomy technique for the Crowe type IV developmental dysplasia of the hip can effectively restore hip function and leg length. The long-term curative effects require further investigations.