| 尚小斌,杨卿,鲁锐,等.人工全髋关节置换联合自体股骨头结构性植骨及转子下截骨治疗Crowe Ⅳ型髋关节发育不良的短期随访.骨科,2017,8(1): 39-43. |
| 人工全髋关节置换联合自体股骨头结构性植骨及转子下截骨治疗Crowe Ⅳ型髋关节发育不良的短期随访 |
| Short-term follow-up of total hip arthroplasty combined with bulk structural autogenous grafts and intertrochanteric osteotomy for Crowe type Ⅳ developmental dysplasia of the hip |
| 投稿时间：2016-09-04 |
| DOI：10.3969/j.issn.1674-8573.2017.01.010 |
| 中文关键词: 髋脱位，先天性 关节成形术，置换，髋 股骨头 移植，自体 截骨术 骨移植 |
| 英文关键词: Hip dislocation, congenital Arthroplasty, replacement, hip Femur head Transplantation, autologous Osteotomy Bone transplantation |
| 基金项目:国家自然科学基金（81541020）；武汉市科技攻关项目（2014060101010048） |
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| 中文摘要: |
| 目的 探讨联合自体股骨头结构性植骨及股骨转子下截骨的人工全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip, DDH）的短期临床效果。方法 回顾性分析2010年1月至2013年12月于我院手术治疗Crowe Ⅳ型DDH的48例（48髋）病人的临床资料，手术均使用非骨水泥组配式S-ROM假体行全髋关节置换术，髋臼均行自体股骨头结构性植骨，并用2~3枚空心拉力螺钉固定，股骨均行小转子下截骨。记录术中截骨长度，术中出血量及输血例数，术中股骨远端骨折例数，术后股神经损伤及静脉血栓发生例数，术后假体松动、假体周围骨折及感染例数。比较病人术前术后的疼痛视觉模拟量表（visual analogue scale, VAS）评分、Harris评分及双下肢长度差异。结果 2例术中出现股骨远端骨折，予以钢丝捆扎术后3个月复查提示骨折端骨性愈合。3例术后出现股神经损伤症状，术后1个月复查时症状均消失。术前患肢较健肢平均短缩（6.3±0.9） cm，患髋的Harris评分为（38.6±5.3）分；术后随访2年时的患肢较健肢平均短缩（1.9±0.7） cm，Harris评分为（89.2±1.4）分；手术前后各指标差异均有统计学意义（均P＜0.05）。随访期间无假体松动、感染，无假体周围骨折。结论 联合自体股骨头结构性植骨及股骨转子下截骨的人工全髋关节置换术是治疗Crowe Ⅳ型DDH的一种有效的手术方式，值得进一步研究。 |
| 英文摘要: |
| Objective To evaluate the efficacy of total hip arthroplasty (THA) combined with bulk structural autogenous grafts and intertrochanteric osteotomy for Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods We retrospectively studied 48 patients (48 hips) with Crowe Ⅳ DDH between January 2010 and December 2013. All patients were subjected to THA with S-ROM non-cement femoral stem prosthesis. Acetabula were treated with autologous femoral bone structural bone grafting fixed with 2-3 hollow tension screw, and femurs were treated with subtrochanteric shortening. The intraoperative osteotomy length, intraoperative bleeding and blood transfusion cases, intraoperative cases of distal femoral fractures, femoral nerve injury and the incidence of venous thrombosis after operation, postoperative prosthesis loosening, periprosthetic fracture and infection cases were recorded. The data before and after operation including Harris scores, VAS scores and the lower limb length differences were compared. Results The distal femoral fractures occurred during operation in 2 cases, and healed with steel wire banding 3 months postoperation. The postoperative femoral nerve injury symptoms occurred in 3 cases, and disappeared one month postoperation. Average preoperative length shortening of the affected limb was (6.3±0.9) cm, and the Harris hip scores were 38.6±5.3. At 2nd year after operation, average postoperative length shortening of the affected limb was (1.9±0.7) cm, and the Harris hip scores were 89.2±1.4, showing statistically differences (P＜0.05 for all) when compared with those preoperation. During the follow-up period, all patients had no prosthesis loosening or infection, and no fracture was found around the prosthesis. Conclusion THA combined with bulk structural autogenous grafts and intertrochanteric osteotomy for Crowe Ⅳ DDH could obtain favorable results, and may be worth further investigation. |
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