CAJ | 학술논문

目的：探讨tHr术中股骨转子下短缩旋转截骨治疗重度ddH的临床应用价值和方法改良。方法对2013年1月—2014年8月间接受非生物型全髋关节置换术的22例(28髋)重度ddH患者术中实施股骨转子下2.5cm处短缩旋转截骨,其中女15髋,男13髋,26~52岁,平均39.1岁，均为crowe分型Ⅲ~iV型患者，股骨前倾术前X线测量平均45.9°，较健侧短缩平均4.5cm，术前Harris评分16~61分，平均为38分，所有患者trendelenburg征阳性。均采用髋关节后外侧入路，常规清理骨赘及增生纤维组织，松解关节囊，完整保护臀中肌，髋臼侧寻找真臼内常规植骨磨臼，植入生物型髋臼假体，股骨试模内支撑下线锯横行截骨（截骨长度2.2cm~4.8cm），短缩并纠正前倾角至15°~20°后，断端采用6孔ao单皮质锁定钢板（lcP）外侧固定，再植入非生物股骨柄，复位后术毕。所有患者术前均不需牵引治疗，术后6周拄双拐下地锻炼，术后12周弃拐行走。结果平均随访时间7个月~37个月，平均21个月，术后Harris评分65~92分，平均为76分，所有股骨侧截骨的病例截骨处均骨性愈合，无假体松动，无神经麻痹，患髋无痛,活动度良好， trendelenburg征阴性，均无需辅助行走。结论 tHr手术股骨远端改良截骨法并单皮质ao锁定钢板固定治疗成人重度ddH，具有良好的疗效。
목적：탐토tHr술중고골전자하단축선전절골치료중도ddH적림상응용개치화방법개량。방법대2013년1월—2014년8월간접수비생물형전관관절치환술적22례(28관)중도ddH환자술중실시고골전자하2.5cm처단축선전절골,기중녀15관,남13관,26~52세,평균39.1세，균위crowe분형Ⅲ~iV형환자，고골전경술전X선측량평균45.9°，교건측단축평균4.5cm，술전Harris평분16~61분，평균위38분，소유환자trendelenburg정양성。균채용관관절후외측입로，상규청리골췌급증생섬유조직，송해관절낭，완정보호둔중기，관구측심조진구내상규식골마구，식입생물형관구가체，고골시모내지탱하선거횡행절골（절골장도2.2cm~4.8cm），단축병규정전경각지15°~20°후，단단채용6공ao단피질쇄정강판（lcP）외측고정，재식입비생물고골병，복위후술필。소유환자술전균불수견인치료，술후6주주쌍괴하지단련，술후12주기괴행주。결과평균수방시간7개월~37개월，평균21개월，술후Harris평분65~92분，평균위76분，소유고골측절골적병례절골처균골성유합，무가체송동，무신경마비，환관무통,활동도량호， trendelenburg정음성，균무수보조행주。결론 tHr수술고골원단개량절골법병단피질ao쇄정강판고정치료성인중도ddH，구유량호적료효。
Objective: to study the clinical application value and method improvement of the short rotation osteotomy of the femur in the treatment of severe tHr with ddH. Method: in January 2013 ~ 2014 august accept non cementless total hip arthroplasty in 22 cases (28 hips) of severe patients with ddH implementation of femur rotor under 2.5cm at shortening rotation osteotomy, which 15 hip female, male 13 hips, 26 to 52 years old, with an average age of 39.1, crowe points type iii to type iV patients, femoral anteversion preoperative X-ray measurement of average 45.9 degrees, compared with the uninvolved short average 4.5cm short, preoperative Harris hip score was 16~61 points, with an average of 38 points, all patients with a positive trendelenburg sign positive. the posterolateral approach to the hip, cleaned routinely osteophytes and hyperplasia of fibrous tissue, loose joint capsule solution, to protect the integrity of the gluteus medius muscle and acetabular side looking for the true acetabulum bone graft routinely grinding mortar, implanted biological type acetabular prosthesis femoral trial mold support offiine saw transverse osteotomy, osteotomy length 2.2cm-4.8cm), shortening and correction of anteversion to 15 degrees to 20 degrees, the broken ends by six hole ao unicortical locking plate (lcP)昀xed to the outside, then implanted in non biological femoral stem, the reset operation completed. all the patients were without traction, crutches under exercise on 6 weeks after operation, postoperative 12 weeks walking without crutch. the average follow-up time was 7 months-37 months, the average of 21 months, the Harris score was 76 points, the average score was points, all of the cases of the femoral side osteotomy bone healing, no prosthesis loosening, no nerve paralysis, suffering from hip pain, good activity, trendelenburg negative, no need to support walking. Conclusion: of thr distal femur with modified osteotomy osteotomy and unicortical ao locking platefixation in the treatment of adult patients with ddH, has good curative effect.