摘要
目的评价初次全髋关节置换术治疗伴有晚期髋关节病变的髋关节发育不良患者的临床效果，探讨其技术可行性及操作要点。方法回顾性分析2002年3月至2008年6月因严重髋关节发育不良而行初次全髋关节置换术的35例患者的临床和影像学资料。男11例11髋，女24例28髋；平均年龄（52±6．7）岁。Crowem型27例31髋，Ⅳ型8例8髋。术前平均Harris评分（42．5±5．3）分。均采用非骨水泥型全髋关节假体。结果全部患者随访1-7年，平均46个月。末次随访时Harris评分（86．3±3．4）分，与术前比较差异有统计学意义。优33髋，良5髋，可1髋，优良率97.4％。随访期间未发现髋臼假体周围透光带及松动表现。2例出现术中髋臼骨折，根据骨折稳定性，经多枚螺钉或结构性植骨后卧床6周愈合。3例出现下肢深静脉血栓，经溶栓治疗后血栓消失。5例6髋出现BrookerI级或Ⅱ级异位骨化。11例于术后1年因外伤发生假体远端骨折。结论对伴有晚期髋关节病变的严重髋关节发育不良患者行初次全髋关节置换术时，术前应进行精确测量与评估，术中彻底松解软组织，正确处理髋臼和股骨，术后近期临床效果良好。
Objective To evaluate the clinical results of the primary total hip arthroplasty （THA） for treating severe developmental dysplasia of the hip （DDH） and to explore the practicality and operation points. Methods We investigated and analyzed the clinical and X-ray results of 35 severe DDH patients who received primary THA from March 2002 to June 2008, including 11 males （11 hips） and 24 females （28 hips）, with the average age of 52±6.7 years （ranged 45-71 years）. According to Crowe classification, 27 patients （31 hips） were classified as type Ⅲ and 8 patients （8 hips） as type IV. The mean Harris score was 42.5±5.3 pre-operatively. All the patients received non-cemented prosthesis. Results All patients were followed up for average 46 months （1-7 years）. The mean Harris score was 86.3±3.4 points at the final follow-up, which had statistic significancy. Among these patients, 33 hips had excellent results, 5 hips had good resuhs and 1 hip had fair results. The rate of excellent and good results was 97.4%. During the follow-up period, there was no radio-lucent line or prosthesis loosening. Two cases suffered aeetabular fractures during surgery, and were treated with additional screws or structural bone-grafting according to the fracture stability. After 6 weeks, both fractures healed uneventfully. Three patients developed deep vein thrombosis （DVT） and after thrombolytic therapy, the thrombus disappeared. Heterotopie ossification （Brooker type Ⅰ or type Ⅱ） were found in 5 patients （6 hips）, and the rate of heterotopic ossification was 15.4%. One patient suffered femoral fracture at the level below the femoral prosthetic tip one year after THA due to injury. Conclusion For the severe DDH patients, it＇s neccesary to make precise measurement and accurate evaluation before primary THA, and do thorough soft tissue releasement during operation, fix the aeetabular and femoral prostheses according to bone character and deal with intraoperative fractures properly. Thus good short-term clinical results can be expected.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第2期159-164,共6页
Chinese Journal of Orthopaedics
关键词
关节成形术
置换
髋
髋脱位
先天性
骨关节炎
髋
Arthroplasty, replacement, hip
Hip dislocation, congenital
Osteoarthritis, hip
