摘要
目的 探讨人工全髋关节置换术（total hip arthroplasty，THA）治疗成人Crowe Ⅳ型先天性髋关节发育不良伴脱位的髋臼假体选择及疗效。 方法2008年6月－2012年5月，收治8例8髋Crowe Ⅳ型先天性髋关节发育不良伴脱位女性患者；年龄20～35岁，平均25岁。左髋5例，右髋3例。患髋Harris评分为（53.9 ± 6.6）分。患肢较健侧短缩4～6 cm，平均4.8 cm。X线片示患髋均完全高位脱位。术中采用42～44 mm小号髋臼假体、S-ROM股骨假体并转子下截骨行THA。 结果患者切口均Ⅰ期愈合，无髋关节脱位、坐骨神经损伤发生。术后2 d 1例发生股神经损伤，术后7 d 2例出现无症状下肢肌间静脉血栓形成，均经对症处理后治愈。8例均获随访，随访时间1～5年，平均3年。患者术前跛行步态均明显改善，均恢复日常工作。术后6个月测量患肢长度与健侧相差—1.0～0.6 cm，平均0.4 cm。髋关节Harris评分达（87.6 ± 0.3）分，与术前比较差异有统计学意义（t=1.77，P=0.00）。X线片复查示，股骨截骨处均在术后3～6 个月愈合；髋臼假体-骨界面稳固，无松动。随访期间无假体翻修。 结论使用小号髋臼假体并转子下截骨行THA是治疗成人Crowe Ⅳ型先天性髋关节发育不良伴脱位的有效方法之一，近期疗效较满意，但假体远期生存率仍需进一步观察。
ObjectiveTo study the effectiveness and acetabular prosthesis selection of the total hip arthroplasty （THA） for Crowe type IV congenital dysplasia of the hip with dislocation in adults. MethodsBetween June 2008 and May 2012, 8 adult patients （8 hips） with Crowe type IV congenital dysplasia of the hip with dislocation underwent THA. They were all female, aged 20-35 years with a mean age of 25 years. The left hip was involved in 5 cases and the right hip in 3 cases. The Harris score of involved hip was 53.9 ± 6.6. The shortened length of involved extremity was 4-6 cm （mean, 4.8 cm）. The X-ray films showed complete dislocation in all cases. The acetabular prosthesis with diameter of 42-44 mm and S-ROM femoral prosthesis were used in THA. ResultsThe incisions healed by first intention. There was no hip dislocation events and sciatic nerve injury during the follow-up. Femoral nerve injury occurred in 1 case and asymptomatic venous thrombosis of the leg muscle occurred in 2 cases. All the patients were followed up 1-5 years （mean, 3 years）. All cases showed obvious improvement of claudication and could restore to work. At 6 months after operation, the mean length difference between affected and contralateral extremities was 0.4 cm （range, —1.0-0.6 cm）; the Harris score was significantly increased to 87.6 ± 0.3 （t=1.77, P=0.00）. The X-ray films showed that all cases got bony union at 3-6 months after operation and stable interface between acetabular prosthesis and bone. No revision was involved during the follow-up. ConclusionTHA with small acetabular cup and subtrochanteric osteotomy is an effective method in the treatment of Crowe type IV congenital dysplasia of the hip with dislocation in adults. The early effectiveness is satisfactory. The long-term survival rate of prosthesis needs to be followed up.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第10期1153-1156,共4页
Chinese Journal of Reparative and Reconstructive Surgery
作者简介
通讯作者：张文明，副教授，硕士生导师，研究方向：关节外科，E—mail：zhangwm0591@163．com
