CAJ | 학술논문

目的总结采用自体股骨头结构性植骨治疗髋关节发育不良继发关节炎的中期疗效及并发症.方法回顾性分析2001年10月至2011年12月采用自体股骨头重建髋臼方法治疗36例髋关节发育不良患者资料,其中34例获得30个月以上的临床及影像学完整随访资料,男6例,女28例;年龄28～68岁,平均51岁;均为单侧手术,左侧16例,右侧18例.Crowe分型,Ⅱ型12例,Ⅲ型16例,Ⅳ型6例;所用假体除l例为混合型外,其余均为非骨水泥型.临床随访包括术前、术后Harris评分及各种并发症;影像学评估包括双侧髋关节正位(或骨盆正位)、患侧髋关节侧位X线片,以判断人工假体位置、植骨愈合情况.结果 34例患者均获得随访,随访时间31～153个月,平均64.1个月.术前Harris评分为23～56分,平均35.4分;末次随访时为82～95分,平均89分,其中优28例,良6例,优良率为100％.术后2～8个月,10例出现植骨块吸收.术后4例患者发生髋关节假体脱位,遂均采用闭合复位,其中1例于复位后2个月再次发生脱位,再次采用闭合复位后未再发生脱位;另3例均未再发生脱位.1例患者于术后3个月摔倒后出现假体周围骨折,行骨折切开复位钢板内固定术,1年随访时骨折已愈合,至末次随访时假体及内固定位置良好、骨折愈合良好,患髋功能良好.术后1年,1例患者因高血压颅内出血行保守治疗后关节置换侧偏瘫,关节失用.结论自体股骨头重建髋臼治疗髋关节发育不良整体疗效满意,骨吸收是结构性植骨的一个自然过程,关节脱位是髋关节发育不良全髋置换术后的最常见并发症.
목적 총결채용자체고골두결구성식골치료관관절발육불량계발관절염적중기료효급병발증.방법 회고성분석2001년10월지2011년12월채용자체고골두중건관구방법치료36례관관절발육불량환자자료,기중34례획득30개월이상적림상급영상학완정수방자료,남6례,녀28례;년령28～68세,평균51세;균위단측수술,좌측16례,우측18례.Crowe분형,Ⅱ형12례,Ⅲ형16례,Ⅳ형6례;소용가체제l례위혼합형외,기여균위비골수니형.림상수방포괄술전、술후Harris평분급각충병발증;영상학평고포괄쌍측관관절정위(혹골분정위)、환측관관절측위X선편,이판단인공가체위치、식골유합정황.결과 34례환자균획득수방,수방시간31～153개월,평균64.1개월.술전Harris평분위23～56분,평균35.4분;말차수방시위82～95분,평균89분,기중우28례,량6례,우량솔위100％.술후2～8개월,10례출현식골괴흡수.술후4례환자발생관관절가체탈위,수균채용폐합복위,기중1례우복위후2개월재차발생탈위,재차채용폐합복위후미재발생탈위;령3례균미재발생탈위.1례환자우술후3개월솔도후출현가체주위골절,행골절절개복위강판내고정술,1년수방시골절이유합,지말차수방시가체급내고정위치량호、골절유합량호,환관공능량호.술후1년,1례환자인고혈압로내출혈행보수치료후관절치환측편탄,관절실용.결론 자체고골두중건관구치료관관절발육불량정체료효만의,골흡수시결구성식골적일개자연과정,관절탈위시관관절발육불량전관치환술후적최상견병발증.
Objective To evaluate the midterm outcomes of autologous femoral head grafting in total hip arthroplasty for developmental dysplasia of the hip.Methods From October 2001 to December 2011,36 patients (36 hips) with developmental dysplasia of the hip were treated by total hip arthroplasty with autologous femoral head grafting,of which 34 cases were followed up for at least 30 months.There were 6 males and 28 females.16 patients were involved in the left hip and 18 in right hip.The average age at the operation was 51 years (range,28-68 years).According to Crowe classification for developmental dysplasia of the hip,12 were type Ⅱ,16 type Ⅲ,and 6 type Ⅳ.Cementless prostheses were used for all,but one patient,who received a hybrid prosthesis.Clinical outcomes were evaluated according to Harris score and complications.Components migration,periprosthetic bone changes,the polyethylene wear rate were measured radiologically.Components position and bone healing were assessed in the anteriorposterior and lateral X-ray of the hips.Results Thirty-four patients (34 hips) were followed up for an average duration of 64.1 months (range,31-153 months).The average Harris score was 35.4 (range,23-56) preoperatively,and was 89 (range,82-95) at the latest follow-up.Twenty-eight were classified as excellent,and 6 were good,and the excellent and good rate was 100％.10 cases presented with bone absorption 2-8 months postoperatively.Four patients suffered from dislocation after surgery.All the cases were treated successfully with close reduction,except one with redislocation.Close reduction was performed for this case,and no dislocation occurred again.One patient had periprosthetic fracture due to a fall and open reduction and plate fixation was performed.The fracture was healed at 1 year follow-up,with good position of the implants.Another patient had hypertensive intracerebral hemorrhage 1 year after the surgery,who was treated by conservative treatment and had hemiplegia and apraxia of the surgical hip.Conclusion Autologous femoral head grafting for the treatment of developmental dysplasia of the hip has a satisfactory clinical and radiographic outcomes at an average of five-year follow-up.Bone graft absorption is a natural process of structural bone grafting.Joint dislocation is the most common complication of THA in developmental dysplasia of the hip.