CAJ | 학술논문

目的探讨髋臼重建及股骨转子下短缩截骨全髋关节置换治疗CroweⅣ型髋关节发育不良的临床疗效.方法 2003年9月至2012年9月收治CroweⅣ型髋关节发育不良患者21例(24髋),男3例,女18例；年龄28～71岁,平均(54±10)岁.采用髋臼重建,股骨转子下横行短缩截骨,股骨近端非骨水泥假体全髋关节置换术.髋臼成形后联合自体结构性骨移植修复骨缺损,生物型假体或钛网骨水泥重建髋臼.陶瓷-聚乙烯股骨头臼界面17例(20髋),金属-聚乙烯4例(4髋).股骨截骨端自体骨移植18例(21髋),异体骨移植原位钢丝捆扎3例(3髋).术后采用Harris髋关节评分系统评估髋关节功能.结果 3例失访.随访18例(21髋),随访时间0.5～9年,平均3.5年.Harris髋关节评分从术前(47.9±9.1)分提高至术后6个月(88.4±3.5)分.术后髋关节疼痛明显改善,肢体活动度增加,步态接近正常.1例术后并发坐骨神经麻痹,无伤口感染病例.术后6个月X线片均显示髋臼假体骨性覆盖、假体及植骨床压配较好,无髋臼假体松动及植骨块明显吸收,截骨端骨愈合良好.结论髋臼重建及股骨转子下短缩截骨全髋关节置换适用于CroweⅣ型髋关节发育不良,尤其是高龄髋关节高脱位患者.操作相对简单,能够改善肢体不等长,可避免一次性过度肢体延长导致的坐骨神经损伤.
목적 탐토관구중건급고골전자하단축절골전관관절치환치료CroweⅣ형관관절발육불량적림상료효.방법 2003년9월지2012년9월수치CroweⅣ형관관절발육불량환자21례(24관),남3례,녀18례；년령28～71세,평균(54±10)세.채용관구중건,고골전자하횡행단축절골,고골근단비골수니가체전관관절치환술.관구성형후연합자체결구성골이식수복골결손,생물형가체혹태망골수니중건관구.도자-취을희고골두구계면17례(20관),금속-취을희4례(4관).고골절골단자체골이식18례(21관),이체골이식원위강사곤찰3례(3관).술후채용Harris관관절평분계통평고관관절공능.결과 3례실방.수방18례(21관),수방시간0.5～9년,평균3.5년.Harris관관절평분종술전(47.9±9.1)분제고지술후6개월(88.4±3.5)분.술후관관절동통명현개선,지체활동도증가,보태접근정상.1례술후병발좌골신경마비,무상구감염병례.술후6개월X선편균현시관구가체골성복개、가체급식골상압배교호,무관구가체송동급식골괴명현흡수,절골단골유합량호.결론 관구중건급고골전자하단축절골전관관절치환괄용우CroweⅣ형관관절발육불량,우기시고령관관절고탈위환자.조작상대간단,능구개선지체불등장,가피면일차성과도지체연장도치적좌골신경손상.
Objective To evaluate the clinical efficacy of total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip.Methods From September 2003 to September 2012,21 patients (24 hips) underwent total hip arthroplasty with subtrochanteric femoral shortening osteotomy for Crowe Ⅳ developmental dysplasia of the hip in our hospital.There were 3 males and 18 females,aged from 28 to 71 years (average,54±10 years).The ceramicpolyethylene articulation was used in 17 patients (20 hips),and metal-polyethylene articulation in 4 patients (4 hips).The osteotomy site was treated with autologous bone graft in 18 patients (21 hips) and allogeneic bone graft in 3 patients (3 hips).The Harris hip score was used to assess the clinical results.Results A total of 18 patients were followed up for 0.5 to 9 years (average,3.5 years).The Harris hip score was improved from preoperative 47.9±9.1 to 88.4±3.5 at 6 months postoperatively.For most patients,hip pain relieved significantly; range of motion of the hip was improved,and the gait returned to normal.Sciatic nerve palsy occurred in 1 patient.There was no wound infection.X-rays 6 months after operation showed that the position of prostheses was satisfactory,without loosening of prostheses and bone block resorption.Conclusion Total hip arthroplasty with subtrochanteric femoral shortening osteotomy can achieve good clinical effect in Crowe Ⅳ developmental dysplasia of the hip.Moreover,it can improve leg length discrepancy and decrease the risk of sciatic nerve injury.