实用骨科杂志
實用骨科雜誌
실용골과잡지
JOURNAL OF PRACTICAL ORTHOPEDICS
2014年
11期
977-981
,共5页
汪锡龙%尚希福%贺瑞%李旭
汪錫龍%尚希福%賀瑞%李旭
왕석룡%상희복%하서%리욱
髋脱位%先天性%骨关节炎%关节成形术%置换
髖脫位%先天性%骨關節炎%關節成形術%置換
관탈위%선천성%골관절염%관절성형술%치환
hip dislocation%congenital%osteoarthritis%arthroplasty%replacement
目的：探讨非骨水泥型髋关节置换术治疗髋臼发育不良的早期效果。方法回顾性分析2009—2013年我科非骨水泥全髋关节置换术治疗因髋臼发育不良导致的髋骨关节炎患者66例72髋，其中男9例11髋，女57例61髋；年龄46~75岁，平均55岁。按 Crowe 分型，Ⅰ型27例29髋，Ⅱ型17例18髋，Ⅲ型13例14髋，Ⅳ型9例11髋，均伴有不同程度的跛行、活动受限等症状。采用 Harris 评分及术前、术后 X 线片观察评价手术效果。结果术后患者肢体平均延长36 mm。66例患者均获得1~5年随访。除1例不遵守医嘱过度下蹲出现脱位后在全麻下闭合手法复位，所有患者髋臼重建侧植骨均获得愈合，髋关节假体均未出现假体松动。2例自体股骨头植骨区有少量骨吸收，未发现下肢因肢体延长致神经血管损伤症状。术前患者Harris评分（45.05±5.38）分、术前下肢不等长（23.29±19.36）mm、CE 角（4±13.92）°改善至（88.62±3.38）°、（3.26±4.06）mm、（29.27±2.68）°，差异均有统计学意义（P<0.05）。术后髋关节旋转中心距泪滴水平距离为（27.82±1.25）mm，垂直距离（24.14±2.59）mm。结论全髋关节置换治疗髋臼发育不良手术难度大，术前精心手术评估，真臼处髋臼重建及通过适度软组织松解、转子下截骨等方式的非骨水泥型髋关节置换术治疗成人髋关节发育不良可取得显著的早期疗效。
目的：探討非骨水泥型髖關節置換術治療髖臼髮育不良的早期效果。方法迴顧性分析2009—2013年我科非骨水泥全髖關節置換術治療因髖臼髮育不良導緻的髖骨關節炎患者66例72髖，其中男9例11髖，女57例61髖；年齡46~75歲，平均55歲。按 Crowe 分型，Ⅰ型27例29髖，Ⅱ型17例18髖，Ⅲ型13例14髖，Ⅳ型9例11髖，均伴有不同程度的跛行、活動受限等癥狀。採用 Harris 評分及術前、術後 X 線片觀察評價手術效果。結果術後患者肢體平均延長36 mm。66例患者均穫得1~5年隨訪。除1例不遵守醫囑過度下蹲齣現脫位後在全痳下閉閤手法複位，所有患者髖臼重建側植骨均穫得愈閤，髖關節假體均未齣現假體鬆動。2例自體股骨頭植骨區有少量骨吸收，未髮現下肢因肢體延長緻神經血管損傷癥狀。術前患者Harris評分（45.05±5.38）分、術前下肢不等長（23.29±19.36）mm、CE 角（4±13.92）°改善至（88.62±3.38）°、（3.26±4.06）mm、（29.27±2.68）°，差異均有統計學意義（P<0.05）。術後髖關節鏇轉中心距淚滴水平距離為（27.82±1.25）mm，垂直距離（24.14±2.59）mm。結論全髖關節置換治療髖臼髮育不良手術難度大，術前精心手術評估，真臼處髖臼重建及通過適度軟組織鬆解、轉子下截骨等方式的非骨水泥型髖關節置換術治療成人髖關節髮育不良可取得顯著的早期療效。
목적：탐토비골수니형관관절치환술치료관구발육불량적조기효과。방법회고성분석2009—2013년아과비골수니전관관절치환술치료인관구발육불량도치적관골관절염환자66례72관，기중남9례11관，녀57례61관；년령46~75세，평균55세。안 Crowe 분형，Ⅰ형27례29관，Ⅱ형17례18관，Ⅲ형13례14관，Ⅳ형9례11관，균반유불동정도적파행、활동수한등증상。채용 Harris 평분급술전、술후 X 선편관찰평개수술효과。결과술후환자지체평균연장36 mm。66례환자균획득1~5년수방。제1례불준수의촉과도하준출현탈위후재전마하폐합수법복위，소유환자관구중건측식골균획득유합，관관절가체균미출현가체송동。2례자체고골두식골구유소량골흡수，미발현하지인지체연장치신경혈관손상증상。술전환자Harris평분（45.05±5.38）분、술전하지불등장（23.29±19.36）mm、CE 각（4±13.92）°개선지（88.62±3.38）°、（3.26±4.06）mm、（29.27±2.68）°，차이균유통계학의의（P<0.05）。술후관관절선전중심거루적수평거리위（27.82±1.25）mm，수직거리（24.14±2.59）mm。결론전관관절치환치료관구발육불량수술난도대，술전정심수술평고，진구처관구중건급통과괄도연조직송해、전자하절골등방식적비골수니형관관절치환술치료성인관관절발육불량가취득현저적조기료효。
Objective To discuss and explore the safety and efficacy of cementless total hip replacement for osteoarthritis due to developmental dysplasia of the hip. Methods We retrospectively investigated the clinical data of 66 patients(72 hips) who had received cementless total hip arthroplasty from May 2009 to May 2013. In this paper,72 total hip replacements were studied clinically and radiologically before and after surgery,with a mean follow-up of 4. 2 years,using Crowe's classification and Harris Hip Score. Results The average Harris Hip Score improved from 45. 05 to 88. 62(t = - 58. 22,P < 0. 05). Mean leg lengthening was 20. 03 mm,with a leg length discrepancy which passed from a mean of 23. 29 mm to a mean of 3. 26 mm (t = 8. 22,P < 0. 05). The mean of CE angle improved from 4°to 29. 27°(t = - 14. 47,P < 0. 05)and no neurovascular inju-ries. Only one case of postoperative hip dislocation happened and by closed manipulative reduction under general anesthesia. All grafts incorporated and no additional radiographic loosenings were found. Bone resorption was found in 2 hips around the screws not adjacent to the acetabular component and were nonprogressive. Postoperative the mean of horizontal distance be-tween the teardrop and the hip center was(27. 82 ± 1. 25)mm and the average vertical distance was(24. 14 ± 2. 59)mm. Conclusion Total hip replacement(THR)in developmental dysplasia of the hip(DDH)presents some difficulties which re-quire an accurate preoperative evaluation,unusual technical procedures such as positioning of the acetabular component in the true acetabulum,acetabular reconstruction,the subtrochanteric shortening osteotomy and appropriate soft tissue releasing for standard THR,and sometimes,particular prosthetic models. The techniques and principles described in this paper are required to good results in this surgery.
