CAJ | 학술논문

目的探讨不同重建方式恢复单侧CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)的患肢长度后关节功能与患者满意度的差异.方法将21例拟行全髋关节置换术的单侧CroweⅣ型DDH患者随机分为代偿长度组11例(转子下截骨后按照代偿法测得的双下肢长度差重建患肢长度)和绝对长度组10例(按照双下肢绝对长度差重建患肢长度).平均随访10年,比较两组患者Harris髋关节评分和健康调查简表SF-36(the MOS item short form health survey,SF-36)评分；以翻修作为终点,采用Kaplan-Meier生存分析法评估假体生存率；根据症状及X线表现评价关节功能和假体松动情况.结果 17例获得随访,随访时间8～10年.两组患者Harris髋关节评分、主要的SF-36评分和假体生存率的差异无统计学意义,代偿长度组患者SF-36评分的“心理健康”项优于绝对长度组.10例出现聚乙烯磨损,6例出现大转子区严重骨质疏松,3例骨溶解.5例翻修:1例感染、1例假体周围骨折、3例无菌性松动.结论两种不同重建方式的全髋关节置换术后髋关节功能和假体生存率无差异.绝对长度组患者手术满意度低于代偿长度组,术后持续感觉双下肢不等长.
목적 탐토불동중건방식회복단측CroweⅣ형관관절발육불량(developmental dysplasia of the hip,DDH)적환지장도후관절공능여환자만의도적차이.방법 장21례의행전관관절치환술적단측CroweⅣ형DDH환자수궤분위대상장도조11례(전자하절골후안조대상법측득적쌍하지장도차중건환지장도)화절대장도조10례(안조쌍하지절대장도차중건환지장도).평균수방10년,비교량조환자Harris관관절평분화건강조사간표SF-36(the MOS item short form health survey,SF-36)평분；이번수작위종점,채용Kaplan-Meier생존분석법평고가체생존솔；근거증상급X선표현평개관절공능화가체송동정황.결과 17례획득수방,수방시간8～10년.량조환자Harris관관절평분、주요적SF-36평분화가체생존솔적차이무통계학의의,대상장도조환자SF-36평분적“심리건강”항우우절대장도조.10례출현취을희마손,6례출현대전자구엄중골질소송,3례골용해.5례번수:1례감염、1례가체주위골절、3례무균성송동.결론 량충불동중건방식적전관관절치환술후관관절공능화가체생존솔무차이.절대장도조환자수술만의도저우대상장도조,술후지속감각쌍하지불등장.
Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.