摘要
目的 探讨应用锥形股骨近端组配式股骨柄假体行人工全髋关节置换（total hip arthroplasty,THA）治疗发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的近期疗效。方法 2010年10月-2012年5月,采用锥形股骨近端组配式股骨柄假体行THA治疗28例（31髋）DDH伴继发性骨关节炎。男2例,女26例;年龄47～77岁,平均61岁。单髋25例,双髋3例。根据Crowe分型标准：Ⅰ型22髋,Ⅱ型8髋,Ⅲ型1髋。术前患者双下肢均不等长,相差（1.6±0.8）cm。髋关节活动度：屈曲（76.1±12.8）°、外展（14.5±6.7）°、内收（9.0±4.5）°、内旋（13.1±6.4）°、外旋（11.7±7.0）°。髋关节Harris评分为（44.7±11.1）分。结果 术中2例（2髋）发生股骨颈截骨面处骨裂,给予钢丝固定后愈合。术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12～32个月,平均20个月。末次随访时,患者双下肢不等长相差（1.0±0.5）cm,与术前比较差异有统计学意义（t=—3.512,P=0.002）。髋关节活动度：屈曲（102.9±10.1）°、外展（32.9±6.0）°、内收（19.2±4.3）°、内旋（34.4±4.2）°、外旋（32.3±5.1）°,与术前比较差异均有统计学意义（P〈0.05）。髋关节Harris评分为（90.3±6.1）分,与术前比较差异有统计学意义（t=21.263,P=0.000）。X线片示2髋假体1年内出现进行性下沉（〈2 mm）;其余假体均无下沉、松动及断裂。髋臼假体无骨溶解或松动。2髋发生异位骨化。结论 采用锥形股骨近端组配式股骨柄假体行THA治疗DDH近期疗效满意,中远期疗效需进一步观察。
Objective To analyze and summarize the short-term effectiveness of total hip arthroplasty （THA） with a tapered, modular neck hip stem for developmental dysplasia of the hip （DDH）. Methods Between October 2010 and May 2012, 28 patients （31 hips） with DDH and secondary osteoarthritis underwent THA with a tapered, modular neck hip stem. There were 2 males and 26 females, with an average age of 61 years （range, 47-77 years）. The unilateral hip was involved in 25 cases and bilateral hips in 3 cases. According to the Crowe system, 22 cases were classified as Crowe type 1, 8 as Crowe type II, and 1 as Crowe type III. At preoperation, the leg length discrepancy was （1.6 ± 0.8） cm; the hip range of motion values were （76.1 ±12.8）° in flexion, （14.5± 6.7）° in abduction, （9.0 ±4.5）° in adduction, （13.1 ± 6.4）° in internal rotation, and （11.7 ± 7.0）° in external rotation; and the Harris hip score was 44.7 ± 11.1. Results Femoral neck fracture occurred in 2 cases （2 hips） during operation, which healed by fixed with steel wire. The incisions healed by first intention. No related complication occurred. The mean follow- up time was 20 months （range, 12-32 months）. At last follow-up, the leg length discrepancy was significant decreased to （1.0±0.5） cm （t=- -3.512, P=-0.002）. The hip range of motion values were （102.9±10.1）° in flexion, （32.9 ±6.0）° in abduction, （19.2± 4.3）° in adduction, （34.4± 4.2）° in internal rotation, and （32.3±5.1）° in external rotation, all showing significant differences when compared with preoperative values （P 〈 0.05）. The Harris hip score was significantly improved to 90.3 ± 6.1 （t=-21.263, P=0.000）. The X-ray films showed no subsidence, loosening, or breakage in the other cases except 2 cases having subsidence （〈 2 mm） within 1 year. Heterotopic ossification occurred in 2 hips. Conclusion The short-term effectiveness of THA with a tapered, modular neck hip stem for DDH is satisfactory. However, the medium and long-term effectiveness still need further follow-up.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第4期428-431,共4页
Chinese Journal of Reparative and Reconstructive Surgery
作者简介
通讯作者：徐耀增，主任医师，博士生导师，研究方向：关节与创伤外科，E-mail：xuyaozeng@163．com
