摘要
目的对Crowe Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者初次人工全髋关节置换术(total hip arthroplasty,THA)后翻修手术的研究进展进行综述。方法回顾近年来有关Crowe Ⅳ型DDH患者初次THA术后翻修的研究文献,分析翻修手术原因,归纳翻修手术难点、处理方法以及相关假体选择。结果Crowe Ⅳ型DDH患者髋臼前后径小、髋臼及股骨前倾角变异大、软组织挛缩严重,THA及翻修手术难度均较大。导致此类患者初次置换后翻修的原因较多,主要为假体无菌性松动。因此,初次THA时需尽可能恢复异常解剖结构、减少磨损颗粒产生,以避免术后假体松动发生。Crowe Ⅳ型DDH患者由于其解剖结构特殊,翻修术中常存在髋臼侧及股骨侧骨缺损,对于骨缺损的修复重建成为手术关键。其中,髋臼侧通常根据骨缺损程度选择合适的髋臼杯或联合金属块、Cage、定制组件等进行重建,股骨侧则首选S-ROM假体。此外,假体界面应尽可能选择陶瓷-陶瓷或陶瓷-高交联聚乙烯。结论Crowe Ⅳ型DDH患者初次THA术后导致翻修的原因以及手术难点已明确,大量临床研究基于此提出了相应的翻修方式并获得了较好早中期疗效,但远期疗效仍需进一步随访明确。随着技术发展与新型材料的研发,制备此类患者的个性化适配假体有望成为现实。
Objective To review research advances of revision surgery after primary total hip arthroplasty(THA)for patients with Crowe type Ⅳ developmental dysplasia of the hip(DDH).Methods The recent literature on revision surgery after primary THA in patients with Crowe type Ⅳ DDH was reviewed.The reasons for revision surgery were analyzed and the difficulties of revision surgery,the management methods,and the related prosthesis choices were summarized.Results Patients with Crowe type Ⅳ DDH have small anteroposterior diameter of the acetabulum,large variation in acetabular and femoral anteversion angles,severe soft tissue contractures,which make both THA and revision surgery more difficult.There are many reasons for patients undergoing revision surgery after primary THA,mainly due to aseptic loosening of the prosthesis.Therefore,it is necessary to restore anatomical structures in primary THA,as much as possible and reduce the generation of wear particles to avoid postoperative loosening of the prosthesis.Due to the anatomical characteristics of Crowe type Ⅳ DDH,the patients have acetabular and femoral bone defects,and the repair and reconstruction of bone defects become the key to revision surgery.The acetabular side is usually reconstructed with the appropriate acetabular cup or combined metal block,Cage,or custom component depending on the extent of the bone defect,while the femoral side is preferred to the S-ROM prosthesis.In addition,the prosthetic interface should be ceramicceramic or ceramic-highly cross-linked polyethylene wherever possible.Conclusion The reasons leading to revision surgery after primary THA in patients with Crowe type Ⅳ DDH and the surgical difficulties have been clarified,and a large number of clinical studies have proposed corresponding revision modalities based on which good early-and midterm outcomes have been obtained,but further follow-up is needed to clarify the long-term outcomes.With technological advances and the development of new materials,personalized prostheses for these patients are expected to become a reality.
作者
刘懿
李叔强
程奇胜
穆杰
LIU Yi;LI Shuqiang;CHENG Qisheng;MU Jie(Department of Orthopedic Center,Bethune First Hospital of Jilin University,Changchun Jilin,130012,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第12期1548-1555,共8页
Chinese Journal of Reparative and Reconstructive Surgery
作者简介
通信作者:李叔强,Email:shuqiang@jlu.edu.cn。
