CAJ | 학술논문

目的：分析髋关节表面置换术治疗髋关节发育不良（developmental dysplasia of the hip，DDH）的临床疗效，探讨以稍大外展角度放置髋臼杯增加股骨头假体直径的可能性。方法2006年10月至2009年9月采用髋关节表面置换术治疗DDH患者32例34髋，男8例9髋，女24例25髋；年龄22~59岁，平均（44.6±11.85）岁。同一时期同一术者采用全髋关节置换术治疗DDH患者32例35例，男8例8髋，女25例27髋；年龄24~56岁，平均（43.7±10.4）岁。采用Harris髋关节评分评价髋关节功能，根据X线片评估关节稳定性及髋臼杯外展角。结果髋关节表面置换组平均随访6.2年，Harris髋关节评分由术前平均（54.9±13.2）分提高至末次随访平均（97.3±6.2）分，其中髋关节屈曲角度平均127°±6.9°；全髋关节置换组平均随访5.9年，Harris髋关节评分由术前平均（51.6±19.7）分提高至末次随访平均（95.6±7.9）分，其中髋关节屈曲角度117°±4.2°。两组髋关节屈曲角度的差异有统计学意义（P＜0.05)。髋关节表面置换组骨盆正位X线片髋臼杯外展角平均51.6°±5.33°，全髋关节置换组平均43.9°±4.90°，两组差异有统计学意义（P＜0.05)。髋关节表面置换组股骨头假体直径平均（46.5±1.5）mm。随访期间两组均无松动、骨折、炎性假瘤及假体相关感染等并发症发生。结论相对于全髋关节置换，表面置换术治疗DDH能获得更好的髋关节功能和更大的活动范围。采用加大外展角放置臼杯的方法，可以允许使用更大的髋臼杯和股骨头假体，可能有利于假体的长期稳定性。
목적：분석관관절표면치환술치료관관절발육불량（developmental dysplasia of the hip，DDH）적림상료효，탐토이초대외전각도방치관구배증가고골두가체직경적가능성。방법2006년10월지2009년9월채용관관절표면치환술치료DDH환자32례34관，남8례9관，녀24례25관；년령22~59세，평균（44.6±11.85）세。동일시기동일술자채용전관관절치환술치료DDH환자32례35례，남8례8관，녀25례27관；년령24~56세，평균（43.7±10.4）세。채용Harris관관절평분평개관관절공능，근거X선편평고관절은정성급관구배외전각。결과관관절표면치환조평균수방6.2년，Harris관관절평분유술전평균（54.9±13.2）분제고지말차수방평균（97.3±6.2）분，기중관관절굴곡각도평균127°±6.9°；전관관절치환조평균수방5.9년，Harris관관절평분유술전평균（51.6±19.7）분제고지말차수방평균（95.6±7.9）분，기중관관절굴곡각도117°±4.2°。량조관관절굴곡각도적차이유통계학의의（P＜0.05)。관관절표면치환조골분정위X선편관구배외전각평균51.6°±5.33°，전관관절치환조평균43.9°±4.90°，량조차이유통계학의의（P＜0.05)。관관절표면치환조고골두가체직경평균（46.5±1.5）mm。수방기간량조균무송동、골절、염성가류급가체상관감염등병발증발생。결론상대우전관관절치환，표면치환술치료DDH능획득경호적관관절공능화경대적활동범위。채용가대외전각방치구배적방법，가이윤허사용경대적관구배화고골두가체，가능유리우가체적장기은정성。
Objective To assess the functional restoration in patients with developmental dysplasia of the hip (DDH) who underwent hip resurfacing arthroplasty and to determine whether greater abduction angle of the acetabular component is relat?ed to larger diameter of femoral head component. Methods We reviewed 34 DDH cases (9 hips of 8 males and 25 hips of 24 fe?males, mean age 44.6±11.85 years at the time of surgery) on whom we performed hip resurfacing arthroplasty (HRA) from October 2006 to September 2009. The total hip Arthroplasty (THA) group was consisted of 35 DDH cases (8 hips of 8 males and 27 hips of 25 females, mean age 43.7±10.4 years at the time of surgery). All operations were performed by the same doctor over the same peri?od. Assessment of the functional hip scores was conducted by Harris Hip Scores. A radiographic study was also performed to evalu?ate the implants stability and abduction angle of the acetabular components. All the data was analyzed with Kolmogorov?Smirnov method. Results The mean follow?up was 6.2 years in the HRA group. The Harris Hip Score improved from 54.9±13.2 to 97.3± 6.2 after the surgery. The mean abduction angle of the acetabular component was 51.6° ± 5.33°, hip flexion was 127° ± 6.9° and mean diameter of femoral head was 46.5±1.5 mm. The mean follow?up was 5.9 years in the THA group. The Harris Hip Score im?proved from 51.6±19.7 to 95.6±7.9 after the surgery. The mean abduction angle of the acetabular component was 43.9°±4.90°, hip flexion was 117°±4.2°. There was no failure of the prosthesis, peri?prosthetic fracture and infection in either group. There was sig?nificant difference in the abduction angle of the acetabular component (P<0.05) and flexion of the hip between the two groups (P<0.05). Conclusion Patients in the HRA group had a better functional restoration and larger range of motion. Furthermore, a larger diameter of femoral head component could be achieved by placing the acetabular component in a greater abduction angle, which may contribute to a better long?term stability.