CAJ | 학술논문

背景:人工全髋关节置换是公认的治疗成人髋关节发育不良晚期髋关节病变的有效手段,但存在较多的困难及风险.目的:评估行大转子截骨的非骨水泥全髋置换治疗Crowe Ⅳ型成人髋关节发育不良的短期疗效.方法:18例(22髋)成人Crowe Ⅳ型发育性髋关节脱位患者采用后外侧入路非骨水泥固定,行大转子截骨调整臀中肌张力,在髋臼的解剖位置安放臼杯.结果与结论:患者随访均超过10个月,最长随访38个月.患者关节置换前平均患肢短缩4.5 cm (3.4-6.0 cm),置换后患肢较置换前平均延长4.0 cm(3.2-4.8 cm).置换后最终随访时Harris评分平均87分(79分-91分),显著高于置换前(P<0.01).置换中3例3髋股骨近端发生骨折,但股骨假体稳定,予钢丝固定或未作特殊处理,均于置换后2个月复查X射线片提示骨折已愈合.1例置换后出现坐骨神经麻痹症状,3个月后症状消失.未出现置换后髋关节脱位、假体松动、感染及有临床表现的深静脉血栓形成等并发症.表明行大转子截骨的非水泥假体能有效治疗Crowe Ⅳ型成人发育性髋关节脱位,能重建复杂髋关节发育不良的生物学及生物力学,不增加并发症风险.
배경:인공전관관절치환시공인적치료성인관관절발육불량만기관관절병변적유효수단,단존재교다적곤난급풍험.목적:평고행대전자절골적비골수니전관치환치료Crowe Ⅳ형성인관관절발육불량적단기료효.방법:18례(22관)성인Crowe Ⅳ형발육성관관절탈위환자채용후외측입로비골수니고정,행대전자절골조정둔중기장력,재관구적해부위치안방구배.결과여결론:환자수방균초과10개월,최장수방38개월.환자관절치환전평균환지단축4.5 cm (3.4-6.0 cm),치환후환지교치환전평균연장4.0 cm(3.2-4.8 cm).치환후최종수방시Harris평분평균87분(79분-91분),현저고우치환전(P<0.01).치환중3례3관고골근단발생골절,단고골가체은정,여강사고정혹미작특수처리,균우치환후2개월복사X사선편제시골절이유합.1례치환후출현좌골신경마비증상,3개월후증상소실.미출현치환후관관절탈위、가체송동、감염급유림상표현적심정맥혈전형성등병발증.표명행대전자절골적비수니가체능유효치료Crowe Ⅳ형성인발육성관관절탈위,능중건복잡관관절발육불량적생물학급생물역학,불증가병발증풍험.
BACKGROUND:Total hip arthroplasty is considered as an effective method for the treatment of hip dysplasia with advanced hip disease, but there exists many difficulties and risks. OBJECTIVE:To evaluate the short-term outcome of cementless total hip arthroplasy for the treatment of Crowe- Ⅳdevelopmental dysplasia of the hip. METHODS:Eighteen adult patients (22 hips) with Crowe-Ⅳdevelopmental dysplasia of the hip underwent primary total hip arthroplasty. Al cases were accomplished through posterolateral approach bone cement fixation, and the greater trochanter osteotomy was performed to adjust the gluteal muscle tension. The acetabular cups were established at the level of the true acetabulum as near as possible. RESULTS AND CONCLUSION:Al the patients were fol owed-up for more than 10 months, and the longest fol ow-up time was 38 months. The mean lower limb length was 4.5 cm (3.4-6.0 cm) before surgery, and it was 4.0 cm longer than that before surgery (range 3.2-4.8 cm). The mean Harris hip score at the final fol ow-up after surgery was 87 (range 79-91) and was significantly increased than that before surgery (P<0.01). During the replacement, 3 cases (3 hips) suffered from fracture with femoral prosthesis stability. And these three cases were treated with wire fixation or without any special treatment, and the X-ray film at 2 months after treatment showed that the fractures were healed. One case had the symptoms of sciatic nerve palsy after replacement and 3 months later, the symptoms disappeared. There was no loosening, dislocation, infection or deep venous thrombosis in any patient. Cementless total hip arthroplasty with osteotomy of the greater trochanter for Crowe-Ⅳ developmental dysplasia of the hip was an effective procedure to establish the biomechanics and improve the function of the hip.