CAJ | 학술논문

目的：探讨非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良的临床疗效。方法2007年10月至2010年1月应用非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良患者32例，男12例，女20例；年龄23~60岁，平均（49.4±9.7）岁。对侧髋关节正常15例，无关节炎及脱位表现的轻度髋臼发育不良17例。通过有限软组织松解、撬拨复位实现真臼重建，不行股骨短缩截骨。术后对患者满意度、髋关节功能恢复、双下肢不等长、骨盆倾斜等情况进行评估。结果所有患者均获得随访，随访时间1~6年，平均（4.0±1.5）年。Harris髋关节评分由术前（36.5±10.3）分（20~63分）提高至末次随访时（89.8±4.9）分（80~97分），两者差异有统计学意义。Harris髋关节评估优16例、良16例，优良率100%。患者满意率93.8%（30/32）。术后均有不同程度的骨盆向患侧倾斜，随时间延长双下肢相对长度差逐渐缩小，骨盆倾斜逐渐矫正。末次随访时双下肢相对长度差（7.3±4.4）mm，髂腰角-0.1°±1.4°。9例出现术后膝关节轻度外翻，末次随访时仍有4例残存膝关节轻度外翻，长距离行走出现大腿外侧及膝关节酸胀不适。2例有术后股神经牵拉损伤，未行特殊处理，分别于术后1个月和3个月完全恢复。随访期间无髋关节脱位、假体感染、假体松动或失败发生。结论在脊柱柔韧性较好的前提下，通过非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良可获得令人满意的手术效果，术后短期内的术侧肢体过长会随着骨盆倾斜的恢复而逐渐得到矫正。
목적：탐토비절골전관관절치환술치료단측CroweⅣ형관관절발육불량적림상료효。방법2007년10월지2010년1월응용비절골전관관절치환술치료단측CroweⅣ형관관절발육불량환자32례，남12례，녀20례；년령23~60세，평균（49.4±9.7）세。대측관관절정상15례，무관절염급탈위표현적경도관구발육불량17례。통과유한연조직송해、효발복위실현진구중건，불행고골단축절골。술후대환자만의도、관관절공능회복、쌍하지불등장、골분경사등정황진행평고。결과소유환자균획득수방，수방시간1~6년，평균（4.0±1.5）년。Harris관관절평분유술전（36.5±10.3）분（20~63분）제고지말차수방시（89.8±4.9）분（80~97분），량자차이유통계학의의。Harris관관절평고우16례、량16례，우량솔100%。환자만의솔93.8%（30/32）。술후균유불동정도적골분향환측경사，수시간연장쌍하지상대장도차축점축소，골분경사축점교정。말차수방시쌍하지상대장도차（7.3±4.4）mm，가요각-0.1°±1.4°。9례출현술후슬관절경도외번，말차수방시잉유4례잔존슬관절경도외번，장거리행주출현대퇴외측급슬관절산창불괄。2례유술후고신경견랍손상，미행특수처리，분별우술후1개월화3개월완전회복。수방기간무관관절탈위、가체감염、가체송동혹실패발생。결론재척주유인성교호적전제하，통과비절골전관관절치환술치료단측CroweⅣ형관관절발육불량가획득령인만의적수술효과，술후단기내적술측지체과장회수착골분경사적회복이축점득도교정。
Objective To evaluate the clinical efficacy of total hip arthroplasty (THA) with no femoral shortening oste?otomy for unilateral CroweⅣ developmental dysplasia of hip. Methods From October 2007 to January 2010, 32 patients with CroweⅣdevelopmental dysplasia of hip in one side underwent THA, including 20 females and 12 males, with an average age of 49.4 ± 9.7 years (range, 23-60 years). There were 15 cases as normal and 17 as mild developmental dysplasia of hip in the other side. The THA were performed with requisite soft tissue release and direct leverage using an elevator but with no femoral shorten?ing osteotomy. The patients' satisfaction, Harris hip score, bilateral leg?length discrepancy and pelvic obliquity was used to assess the clinical results. Results All of patient were followed up for 1-6 years, average 4.0 ± 1.5 years. No loosening or failure of component occurred by the end of follow?up. The Harris hip score was improved from preoperative 36.5±10.3 (20-63) to 89.8± 4.9 (80-97), and the excellent and good rate was 100% (excellent 16 cases, good 16 cases). The satisfactory rate was 93.8%(30/32). The leg?length discrepancy of the bilateral sides and the pelvic obliquity was corrected gradually and the gait returns to normal. Nine cases have valgus knee after THA and 4 cases of them felt uncomfortable after long?distance walk. Femoral nerve injury occurred in 2 cases. All of cases recovered after 1 and 3 months respectively. No infection and dislocation oc?curred. Conclusion THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral CroweⅣdevelopmental dysplasia of hip. The discrepancy of leg?length will be diminished with the correction for pelvic obliquity.