CAJ | 학술논문

背景：由于髋关节的异常变，使关节置换手术难度加大、处理困难，其中又以髋臼侧为甚。因此，对髋关节发育不良患者施行全髋关节置换时，对髋臼的处理尤为重要。目的：探讨采用植骨加盖行生物学固定型全髋关节置换治疗 CroweⅢ、Ⅳ型成人髋关节发育不良患者的临床疗效。方法：回顾分析14例髋关节发育不良成人患者，按Crowe方法分型Ⅲ型11例，Ⅳ型3例。所有患者均进行全髋关节置换，置换过程中采用自体般骨颈在髋臼周围做植骨加盖，对置换后及随访时X射线片的影像学资料进行分析，临床疗效采用Harris标准评定。结果与结论：14例髋关节发育不良成人患者均获得随访，随访时间1-9年，平均4.5年。4例患者置换后1年内植骨块发生部分吸收，2年后又重新生长，所有植骨块经X 射线平片证实均与宿主骨愈合，植骨块对髋臼的平均覆盖率为36%，至今无一髋需行翻修，髋关节功能从置换前Harris评分平均35分(26-52分)恢复至末次随访时的平均91分。证实采用自体股骨颈植骨加盖的生物学固定型全髋关节置换是治疗CroweⅢ、Ⅳ型成人髋关节发育不良的有效方法。
배경：유우관관절적이상변，사관절치환수술난도가대、처리곤난，기중우이관구측위심。인차，대관관절발육불량환자시행전관관절치환시，대관구적처리우위중요。목적：탐토채용식골가개행생물학고정형전관관절치환치료 CroweⅢ、Ⅳ형성인관관절발육불량환자적림상료효。방법：회고분석14례관관절발육불량성인환자，안Crowe방법분형Ⅲ형11례，Ⅳ형3례。소유환자균진행전관관절치환，치환과정중채용자체반골경재관구주위주식골가개，대치환후급수방시X사선편적영상학자료진행분석，림상료효채용Harris표준평정。결과여결론：14례관관절발육불량성인환자균획득수방，수방시간1-9년，평균4.5년。4례환자치환후1년내식골괴발생부분흡수，2년후우중신생장，소유식골괴경X 사선평편증실균여숙주골유합，식골괴대관구적평균복개솔위36%，지금무일관수행번수，관관절공능종치환전Harris평분평균35분(26-52분)회복지말차수방시적평균91분。증실채용자체고골경식골가개적생물학고정형전관관절치환시치료CroweⅢ、Ⅳ형성인관관절발육불량적유효방법。
BACKGROUND:Joint replacement surgery becomes difficult because of the abnormal changes in hip joint, especial y on the acetabular side. Therefore, the treatment on acetabulum is very important during total hip arthroplasty in patients with hip dysplasia. OBJECTIVE:To investigate the clinical therapeutic effects of total hip arthroplasty with onlay bone graft for treatment of CroweIII and IV adult hip dysplasia. METHODS:A total of in 14 patients with adult hip dysplasia were retrospectively analyzed. According to Crowe method, there were 11 cases of type III and 3 cases of type IV. Al patients underwent total hip arthroplasty. Autologous femur neck was used to make an onlay bone graft around the acetabulum during replacement. Radiographs were analyzed after replacement and during fol ow-up. Clinical efficacy was assessed using Harris standard. RESULTS AND CONCLUSION:Al patients were fol owed up for 1-9 years, averagely 4.5 years. Bone graft was partial y absorbed within 1 year after replacement in 4 patients, and began to grow 2 years later. Radiographs showed that al bone graft was fused to host bone. The average coverage rate of bone grafts on acetabulum was 36%. None hip was needed to be rebuilt up to now. Harris score of hip joint function increased from 35 points (26-52 points) before surgery to 91 points during final fol ow-up. Total hip arthroplasty with onlay bone graft is an effective method in treatment of CroweIII and IV adult hip dysplasia.