CAJ | 학술논문

目的：观察成人髋关节发育不良（ DDH）终末期骨关节炎髋臼和Harris窝的解剖学特征，探讨复原Harris窝和确定髋臼中心的方法，以准确安装髋臼假体，恢复髋关节旋转中心。方法自2005年3月至2011年2月，对42例（48髋）成人髋关节发育不良终末期骨关节炎施行人工全髋置换术（ THA），其中男6例6髋，女36例42髋。年龄27～62岁（平均45岁）；术前拍摄标准骨盆平片确定Crowe分型，其中CroweⅠ型6髋，Ⅱ型11髋，Ⅲ型20髋，Ⅳ型11髋。采用后外侧入路显露髋臼，观察髋臼和Harris窝的解剖学特征，清除覆盖于Harris窝表面的骨赘，复原出Harris窝和髋臼切迹，并以此为标志确定髋臼中心，磨削髋臼，安装髋臼假体。术后拍摄骨盆平片测量髋关节旋转中心的垂直距离和水平距离，评价旋转中心恢复效果。结果48例成人DDH髋臼呈浅杯形、浅盘形、贝壳形、三角形四种基本病理类型，Harris窝根据骨赘覆盖程度不同呈现出裂隙状、三角状、封闭状、浅平状四种病理类型；根据复原Harris窝及髋臼切迹，确定髋臼中心并安装髋臼假体，手术前后骨盆前后X线片对比髋关节旋转中心：髋关节旋转中心垂直距离术前（37.8±5.2） mm，术后（13.7±2.4） mm，差异有统计学意义（P＜0.05）。髋关节旋转中心水平距离术前（41.6±6.3）mm，术后（24.4±4.7）mm，差异有统计学意义（ P＜0.05）。结论在成人DDH终末期骨关节炎髋臼和Harris窝因脱位程度和骨赘增生程度不同呈现出不同的病理类型，清除覆盖于Harris窝表面的骨赘可以复原出Harris窝和髋臼切迹，以复原后的Harris窝和髋臼切迹为标志确定髋臼中心，安装髋臼假体，可以准确地恢复髋关节旋转中心。
목적：관찰성인관관절발육불량（ DDH）종말기골관절염관구화Harris와적해부학특정，탐토복원Harris와화학정관구중심적방법，이준학안장관구가체，회복관관절선전중심。방법자2005년3월지2011년2월，대42례（48관）성인관관절발육불량종말기골관절염시행인공전관치환술（ THA），기중남6례6관，녀36례42관。년령27～62세（평균45세）；술전박섭표준골분평편학정Crowe분형，기중CroweⅠ형6관，Ⅱ형11관，Ⅲ형20관，Ⅳ형11관。채용후외측입로현로관구，관찰관구화Harris와적해부학특정，청제복개우Harris와표면적골췌，복원출Harris와화관구절적，병이차위표지학정관구중심，마삭관구，안장관구가체。술후박섭골분평편측량관관절선전중심적수직거리화수평거리，평개선전중심회복효과。결과48례성인DDH관구정천배형、천반형、패각형、삼각형사충기본병리류형，Harris와근거골췌복개정도불동정현출렬극상、삼각상、봉폐상、천평상사충병리류형；근거복원Harris와급관구절적，학정관구중심병안장관구가체，수술전후골분전후X선편대비관관절선전중심：관관절선전중심수직거리술전（37.8±5.2） mm，술후（13.7±2.4） mm，차이유통계학의의（P＜0.05）。관관절선전중심수평거리술전（41.6±6.3）mm，술후（24.4±4.7）mm，차이유통계학의의（ P＜0.05）。결론재성인DDH종말기골관절염관구화Harris와인탈위정도화골췌증생정도불동정현출불동적병리류형，청제복개우Harris와표면적골췌가이복원출Harris와화관구절적，이복원후적Harris와화관구절적위표지학정관구중심，안장관구가체，가이준학지회복관관절선전중심。
Objective To observe the anatomical features of acetabulum and Harris fossa in adult end-stage osteoarthritis due to developmental dysplasia of the hip ( DDH) and to discuss the method of restoring Harris fossa and locating acetabular center in order to accurately install the acetabular prosthesis and restore the rotation center of hip.Methods Since March 2005 to February 2011, 42 patients (48 hips) of end-stage osteoarthritis due to adult DDH underwent total hip arthroplasty, including six males with six hips and 36 females with 42 hips.The age was from 27 to 62 years (average, 45 years).The Crowe type was confirmed by standard preoperative pelvic radiograph: six hips of Crowe Ⅰ, 11 hips of CroweⅡ, 20 hips of Crowe Ⅲ, and 11 hips of Crowe Ⅳ.The posterolateral approach was used for the exposure of acetabulum; the anatomical features of acetabulum and Harris fossa were observed, and the osteophyte covering the Harris fossa was removed.Harris fossa and acetabular notch were restored, which were used as the mark for locating the acetabular center, acetabulum reaming and acetabular prosthesis installation.Using the postoperative pelvic radiographs, the vertical and the horizontal distances of hip rotation center were measured and the effects of reconstruction of the rotation center were evaluated. Results The acetabula of 48 patients with adult DDH were classified into four basic pathological types which included the shallow cup shape, the dish shape, the shell-shape and the triangular shape.According to the osteophyte coverage, Harris fossa was classified into four pathological types as the crack shape, the triangle shape, the closed shape and the shallow shape.The acetabuluar center was located and the acetabular prosthesis was installed by restoring Harris fossa and acetabular notch. The vertical and horizontal distances of hip rotation center on the pelvic radiographs before and after surgery were as follows:the preoperative vertical distance of hip rotation center was (37.8 ±5.2) mm, the postoperative one was (13.7 ±2.4 ) mm, which showed statistically significant difference ( P <0.05 ); the preoperative horizontal distance of hip rotation center was (41.6 ±6.3) mm, and the postoperative one was (24.4 ± 4.7) mm, which showed statistically significant difference (P<0.05).Conclusions In the end-stage osteoarthritis due to adult DDH, the acetabulum and Harris fossa may present different pathological types because of different degrees of dislocation and osteophyte hyperplasia.The Harris fossa and acetabular notch can be restored by removing the osteophyte covering Harris fossa.The acetabular prosthesis can be installed and the hip rotation center also can be accurately restored by locating acetabular center using Harris fossa and acetabular notch as the marks.