CAJ | 학술논문

目的：探讨CroweⅣ型髋关节发育不良全髋关节置换术中股骨截骨长度的确定方法。方法2006年2月至2011年2月对11例CroweⅣ型髋关节发育不良患者行股骨转子下截骨全髋关节置换术，男3例，女8例；年龄45~65岁，平均54岁。左髋5例，右髋6例。患肢短缩1.8~6.0 cm，平均3.5 cm。患者均有髋关节及腰骶部疼痛。术前通过“走板”试验结合双下肢站立正位X线片测量确定股骨转子下截骨长度，平衡术后下肢长度。术后3、6、12个月及以后每年门诊随访一次。询问患者腰骶部疼痛改善情况及对手术效果的满意程度，测量双下肢长度差，以Harris髋关节评分评估患侧髋关节功能，摄X线片观察截骨愈合、假体松动及下沉、骨溶解情况。结果全部患者随访3~8年，平均4.5年。截骨长度1.5~4.2 cm，平均2.2 cm。术后患肢较对侧长-1.5~1.5 cm，平均1 cm。髋关节疼痛症状均消失；8例腰骶部疼痛完全消失，3例轻微疼痛，但较术前明显减轻。2例对手术效果满意，9例很满意。无坐骨神经损伤。截骨愈合时间3~12个月，平均5个月。末次随访时Harris髋关节评分从术前平均（45±7.6）分提高至（93±6.6）分，差异有统计学意义。2例分别于术后5年和7年发生股骨假体下沉，下沉高度分别为3 mm和6 mm。无假体松动及术后感染病例。结论对CroweⅣ型DDH患者行全髋关节置换，在真臼部位重建髋臼后应根据患者对肢体延长的耐受程度确定股骨转子下截骨的长度，而术前“走板”试验有利于确定患者的耐受程度，可有效避免或减轻术后由于肢体延长引发的症状，重建双下肢平衡。
목적：탐토CroweⅣ형관관절발육불량전관관절치환술중고골절골장도적학정방법。방법2006년2월지2011년2월대11례CroweⅣ형관관절발육불량환자행고골전자하절골전관관절치환술，남3례，녀8례；년령45~65세，평균54세。좌관5례，우관6례。환지단축1.8~6.0 cm，평균3.5 cm。환자균유관관절급요저부동통。술전통과“주판”시험결합쌍하지참립정위X선편측량학정고골전자하절골장도，평형술후하지장도。술후3、6、12개월급이후매년문진수방일차。순문환자요저부동통개선정황급대수술효과적만의정도，측량쌍하지장도차，이Harris관관절평분평고환측관관절공능，섭X선편관찰절골유합、가체송동급하침、골용해정황。결과전부환자수방3~8년，평균4.5년。절골장도1.5~4.2 cm，평균2.2 cm。술후환지교대측장-1.5~1.5 cm，평균1 cm。관관절동통증상균소실；8례요저부동통완전소실，3례경미동통，단교술전명현감경。2례대수술효과만의，9례흔만의。무좌골신경손상。절골유합시간3~12개월，평균5개월。말차수방시Harris관관절평분종술전평균（45±7.6）분제고지（93±6.6）분，차이유통계학의의。2례분별우술후5년화7년발생고골가체하침，하침고도분별위3 mm화6 mm。무가체송동급술후감염병례。결론대CroweⅣ형DDH환자행전관관절치환，재진구부위중건관구후응근거환자대지체연장적내수정도학정고골전자하절골적장도，이술전“주판”시험유리우학정환자적내수정도，가유효피면혹감경술후유우지체연장인발적증상，중건쌍하지평형。
Objective To investigate the method of controlling leg length in total hip arthroplasty for CroweⅣtype devel?opmental dysplasia of the hip. Methods From February 2006 to February 2011, primary total hip arthroplasty were performed in 11 patients (3 males and 8 females, aged 54 year and ranged from 45 to 65 years) with CroweⅣtype developmental dysplasia of the hip using subtrochanteric femoral osteotomy. Leg length was measured in the method of preoperation plan combining with mea?surement in the course of operation. Five hips were involved in left side, 6 in right side. The average leg length discrepancy were 3.5 cm (ranged, 1.8-6.0 cm). All patients have lumbosacral pain. Clinical and radiographic characteristics were retrospectively re?viewed at the 3, 6 and 12 months after operation. Outpatient follow?up was conducted every year. The lumbosacral pain and degree of patient satisfaction were recorded. Moreover, leg length discrepancy, the bone union, prosthesis subsidence, and the hip Harris score were evaluated. Results Average follow?up was 4.5 years (3-8 years). The average length of resected bone was 2.2 cm (1.5-4.2 cm). The average leg length discrepancy were 1.0 cm (ranged,-1.5-1.5 cm). Lumbosacral pain of 8 patients was eliminated and slight pain was retained in 3 patients. Two patients were satisfied with the result of operation and 9 were extremely satisfied. No nerve injury and nonunion occurred. At the final follow?up, the mean Harris score improved from 45 ± 7.6 before operation to 93±6.6 (P<0.05). The mean union time was 5 months after operation (3-12 months after operation). The prosthesis subsidences were found in one case at the five years after operation and 1 case at the seven years after operation and with subsiding height of 3 mm and 6 mm respectively. No loosening and infection were found in all patients. Conclusion In treating patients with CroweⅣtype developmental hip dysplasia by THA, the length of resected subtrochanteric femoral should be conducted according to pa?tient's tolerance to pain reduced by leg extension. Therefore, the leg length is facilitated to improve the function of joint and to de?crease symptoms reduced by leg extension.