中华解剖与临床杂志
中華解剖與臨床雜誌
중화해부여림상잡지
Chinese Journal of Anatomy and Clinics
2014年
6期
478-482
,共5页
袁涛%包倪荣%孟嘉%周利武%郭亭%赵建宁
袁濤%包倪榮%孟嘉%週利武%郭亭%趙建寧
원도%포예영%맹가%주리무%곽정%조건저
髋脱位,先天性%关节成形术,置换,髋%转子间截骨%转子下截骨
髖脫位,先天性%關節成形術,置換,髖%轉子間截骨%轉子下截骨
관탈위,선천성%관절성형술,치환,관%전자간절골%전자하절골
Hip dislocation,congenital%Arthoplasty,replacement,hip%Transtrochanteric osteotomy%Subtrochanteric osteotomy
目的 研究CroweⅣ型髋关节发育不良(DDH)患者行人工全髋关节置换时采用转子间截骨与转子下截骨治疗的疗效及安全性.方法 回顾性分析1999年5月-2013年12月期间收治的33例(37髋)CroweⅣ型DDH患者,年龄17～67岁,平均35.9岁.在行人工全髋关节置换术中时采取了不同的截骨方式,其中28例(30髋)接受了改进的转子间截骨、5例(7髋)采用了转子下截骨.两组患者均用改良的Merled Aubigné和Postel部分评分进行效果评定,术前平均分别为9.4分、9.7分,下肢长度差异平均分别为44.7 mm、57.5 mm,收集评估临床及影像学检查数据.结果 平均随访时间为83.6个月,术后转子间截骨与转子下截骨患者下肢的平均长度差异分别是9.2 mm、9.4 mm,末次随访Merled Aubign6评分平均分别为15.9分、15.8分.转子间截骨组患者中有2例术后出现坐骨神经麻痹,但是6个月内症状完全缓解.末次随访中转子间截骨组有2例Trendelenburg征阳性.在随访期内均无假体翻修的患者.各组手术前后Merled Aubigné和Postel部分评分差异均有统计学意义(P值均＜0.05),两组间统计学差异均无统计学意义(P＞0.05).结论 人工全髋关节置换术中股骨缩短治疗CroweⅣ型髋关节发育不良时,无论是转子间截骨还是转子下截骨均安全有效.
目的 研究CroweⅣ型髖關節髮育不良(DDH)患者行人工全髖關節置換時採用轉子間截骨與轉子下截骨治療的療效及安全性.方法 迴顧性分析1999年5月-2013年12月期間收治的33例(37髖)CroweⅣ型DDH患者,年齡17～67歲,平均35.9歲.在行人工全髖關節置換術中時採取瞭不同的截骨方式,其中28例(30髖)接受瞭改進的轉子間截骨、5例(7髖)採用瞭轉子下截骨.兩組患者均用改良的Merled Aubigné和Postel部分評分進行效果評定,術前平均分彆為9.4分、9.7分,下肢長度差異平均分彆為44.7 mm、57.5 mm,收集評估臨床及影像學檢查數據.結果 平均隨訪時間為83.6箇月,術後轉子間截骨與轉子下截骨患者下肢的平均長度差異分彆是9.2 mm、9.4 mm,末次隨訪Merled Aubign6評分平均分彆為15.9分、15.8分.轉子間截骨組患者中有2例術後齣現坐骨神經痳痺,但是6箇月內癥狀完全緩解.末次隨訪中轉子間截骨組有2例Trendelenburg徵暘性.在隨訪期內均無假體翻脩的患者.各組手術前後Merled Aubigné和Postel部分評分差異均有統計學意義(P值均＜0.05),兩組間統計學差異均無統計學意義(P＞0.05).結論 人工全髖關節置換術中股骨縮短治療CroweⅣ型髖關節髮育不良時,無論是轉子間截骨還是轉子下截骨均安全有效.
목적 연구CroweⅣ형관관절발육불량(DDH)환자행인공전관관절치환시채용전자간절골여전자하절골치료적료효급안전성.방법 회고성분석1999년5월-2013년12월기간수치적33례(37관)CroweⅣ형DDH환자,년령17～67세,평균35.9세.재행인공전관관절치환술중시채취료불동적절골방식,기중28례(30관)접수료개진적전자간절골、5례(7관)채용료전자하절골.량조환자균용개량적Merled Aubigné화Postel부분평분진행효과평정,술전평균분별위9.4분、9.7분,하지장도차이평균분별위44.7 mm、57.5 mm,수집평고림상급영상학검사수거.결과 평균수방시간위83.6개월,술후전자간절골여전자하절골환자하지적평균장도차이분별시9.2 mm、9.4 mm,말차수방Merled Aubign6평분평균분별위15.9분、15.8분.전자간절골조환자중유2례술후출현좌골신경마비,단시6개월내증상완전완해.말차수방중전자간절골조유2례Trendelenburg정양성.재수방기내균무가체번수적환자.각조수술전후Merled Aubigné화Postel부분평분차이균유통계학의의(P치균＜0.05),량조간통계학차이균무통계학의의(P＞0.05).결론 인공전관관절치환술중고골축단치료CroweⅣ형관관절발육불량시,무론시전자간절골환시전자하절골균안전유효.
Objective To evaluate the efficacy and safety of lesser trochanteric osteotomy and subtrochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods From May 1999 to December 2013,33 cases (37 hips) with Crowe Ⅳ DDH underwent different methods for femoral shortening with femoral resection in total hip replacement.Twenty-eight patients (30 hips) underwent progressive femoral shortening at the level of lesser trochanteric,5 patients (7 hips) accepted subtrochanteric shortening osteotomy,29 cases were unilateral hip and bilateral hip was involved in 4 cases in both packets with an range age of 17-67 years (averaged 35.9 replacement years).A modified Merled Aubigné scale was used in both team,and the score was 9.4,9.7 preoperatively,and the average leg length discrepancy was 44.7 mm,57.5 mm.Clinical and radiographical results were collected and evaluated.A regular follow-up was done after surgery.Results The mean follow-up period was 83.6 months,the average leg length discrepancy of lesser trochanteric osteotomy and subtrochanteric shortening osteotomy were 9.2 mm,9.4 mm postoperatively,and Merled Aubigné scale was improved to 15.9 and 15.8.There were two hips with sciatic nerve palsy in lesser trochanteric osteotomy group after surgery.However,resolved completely in six months,and two cases trendelenburg sign was still positive in this group at the final follow-up.No revision of acetabular and femoral components was required by the final follow-up.Compared with pre-and post-operative in each group,the Meded Aubigné scale and Harris score showed significant difference (all P values ＜ 0.05),no difference existed between two groups (all P values ＞ 0.05).Conclusions Transtrochanteric osteotomy and subtrochanteric shortening osteotomy for femoral shortening in total hip arthroplasty in treatment of Crowe Ⅳ DDH are safe and effective.
