CAJ | 학술논문

背景：对髋关节发育不良患者行人工全髋关节置换术时，臼杯高位安放是一种新理念，而其临床疗效却鲜有报道。 　　目的：探讨采用人工全髋关节置换治疗CroweⅡ、Ⅲ型发育性髋关节发育不良时，非骨水泥臼杯高位安放的短期临床及放射学结果。 　　方法：2011年6月至2013年6月，29例（37髋）CroweⅡ、Ⅲ型髋关节发育不良患者接受人工全髋关节置换术，其臼杯高于解剖旋转中心安放（高旋转中心组）。同期治疗的28例（35髋）CroweⅠ型患者作为对照。比较两组患者的髋关节Harris评分、步态、跛行、Trendelanburg征、放射学检查结果。 　　结果：所有患者随访12~36个月，平均26.4个月。CroweⅡ、Ⅲ型的臼杯旋转中心距泪滴连线的平均垂直距离分别为25.5 mm、29.7 mm，与CroweⅠ型（18.7 mm）比较有显著统计学差异（P=0.02）。末次随访时，高旋转中心组的平均Har-ris评分为92.3分（86~98分），对照组的平均Harris评分为92.8分（84~100分），两组比较无显著统计学差异（P=0.57）。随访时所有患者步态良好，无跛行，Trendelanburg征阴性。 　　结论：人工全髋关节置换治疗CroweⅡ、Ⅲ型发育性髋关节发育不良时，高位安放臼杯是一种可靠的方法，短期临床及放射学结果良好。
배경：대관관절발육불량환자행인공전관관절치환술시，구배고위안방시일충신이념，이기림상료효각선유보도。 　　목적：탐토채용인공전관관절치환치료CroweⅡ、Ⅲ형발육성관관절발육불량시，비골수니구배고위안방적단기림상급방사학결과。 　　방법：2011년6월지2013년6월，29례（37관）CroweⅡ、Ⅲ형관관절발육불량환자접수인공전관관절치환술，기구배고우해부선전중심안방（고선전중심조）。동기치료적28례（35관）CroweⅠ형환자작위대조。비교량조환자적관관절Harris평분、보태、파행、Trendelanburg정、방사학검사결과。 　　결과：소유환자수방12~36개월，평균26.4개월。CroweⅡ、Ⅲ형적구배선전중심거루적련선적평균수직거리분별위25.5 mm、29.7 mm，여CroweⅠ형（18.7 mm）비교유현저통계학차이（P=0.02）。말차수방시，고선전중심조적평균Har-ris평분위92.3분（86~98분），대조조적평균Harris평분위92.8분（84~100분），량조비교무현저통계학차이（P=0.57）。수방시소유환자보태량호，무파행，Trendelanburg정음성。 　　결론：인공전관관절치환치료CroweⅡ、Ⅲ형발육성관관절발육불량시，고위안방구배시일충가고적방법，단기림상급방사학결과량호。
Background:High hip center total hip arthroplasty (THA) for dysplasia is a new concept, and there are few reports on clinical outcomes. Objective: To examine short-term clinical and radiographic results of high hip center cementless THA in patients with CroweⅡandⅢdysplasia. Methods:In this retrospective study, 29 patients (37 hips) with CroweⅡorⅢdysplasia were treated with high hip center cementless THA and 28 patients (35 hips) with CroweⅠdysplasia underwent THA with cementless cups placed at an ana-tomic hip center. ALL surgeries were done between June 2011 and June 2013 by one senior surgeon. Harris hip scores, gait, limp, Trendelanburg sign were recorded. Radiographic results including vertical and horizontal distances of the center of ro-tation in relation to the acetabular teardrop, and the radiolucent line around the prosthesis were analyzed. Results:The mean follow up period was 26.4 months (range, 12-36 months). The mean vertical distance between rotation center and inter-teardrop line in patients with CroweⅡandⅢdysplasia was 25.5 mm and 29.7 mm, respectively, which was significantly larger than that in patients with CroweⅠdysplasia (18.7 mm, P=0.02). The mean Harris hip score of the high hip center group was 92.3 (range, 86-98) at the last follow-up, which was not significantly different from that of the an-atomic hip center group (92.8, ranging, 84-100, P=0.57). All patients had excellent gait without lamp and with negative Trendelanburg sign. Conclusions:For CroweⅡandⅢdysplasia, a high hip center cementless cup without bone graft is a liable method. And satisfying short-term clinical and radiographic results can be achieved by this method.