中国修复重建外科杂志

中国修复重建外科杂志

股骨转子下截骨联合人工全髋关节置换术治疗 Crowe 型先天性髋关节发育不良中期疗效

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目的探讨采用股骨转子下截骨联合人工全髋关节置换术(total hip arthroplasty,THA)治疗 Crowe Ⅳ 型先天性髋关节发育不良(developmental dysplasia of the hip,DDH)的中期疗效。方法 2009 年 9 月—2014 年 3 月,采用股骨转子下截骨联合 THA 治疗 49 例(57 髋)Crowe Ⅳ 型 DDH 患者。其中男 7 例,女 42 例;年龄 20~73 岁,平均 44.6 岁。左髋 26 例、右髋 15 例;双髋 8 例。术前髋关节 Harris 评分(44.68±3.39)分,双下肢不等长(5.27±0.55)cm。结果术后切口均 Ⅰ 期愈合。患者均获随访,随访时间 32~87 个月,平均 52.1 个月。末次随访时,Harris 评分为(85.67±2.89)分,较术前显著提高(t=–69.53,P=0.00);双下肢不等长(1.12±0.48) cm,与术前比较差异有统计学意义(t=42.94,P=0.00)。术后 6 个月 X 线片复查示,截骨端均愈合良好;末次随访复查示假体无松动、下沉。结论采用股骨转子下截骨联合 THA 治疗 Crowe Ⅳ 型 DDH,可降低关节周围血管神经牵拉损伤风险,中期疗效较好。

ObjectiveTo explore the mid-term effectiveness of total hip arthroplasty (THA) with subtrochanteric shortening osteotomy in treatment of Crowe type Ⅳ developmental dysplasia of the hip (DDH).MethodsBetween September 2009 and March 2014, a total of 49 patients (57 hips) who were diagnosed with Crowe type Ⅳ DDH were treated with THA and subtrochanteric shortening osteotomy. Of the 49 patients, 7 were male and 42 were female with an average age of 44.6 years (range, 20-73 years). The preoperative Harris score was 44.68±3.39 and the preoperative leg length discrepancy was (5.27±0.55) cm.ResultsAll incisions healed primarily. All patients were followed up 32-87 months (mean, 52.1 months). At last follow-up, the Harris score was 85.67±2.89 and the leg length discrepancy was (1.12±0.48) cm, showing significant differences when compared with the preoperative values (t=–69.53, P=0.00; t=42.94, P=0.00). X-ray films showed that bone union of the femoral osteotomy end at 6 months after operation. There was no loosening and subsidence of prosthesis at last follow-up.ConclusionThe subtrochanteric shortening osteotomy with THA in treatment of Crowe type Ⅳ DDH can obtain satisfactory mid-term effectiveness with low risk of peripheral vascular and nerve traction injuries.

关键词: 先天性髋关节发育不良; 人工全髋关节置换术; 股骨转子下截骨; 中期疗效

Key words: Developmental dysplasia of the hip; total hip arthroplasty; subtrochanteric osteotomy; mid-term effectiveness

引用本文: 尹诗九, 李锐博, 牟平, 钟航, 杨静. 股骨转子下截骨联合人工全髋关节置换术治疗 Crowe 型先天性髋关节发育不良中期疗效 . 中国修复重建外科杂志, 2018, 32(4): 385-388. doi: 10.7507/1002-1892.201711053 复制

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