摘要
[目的]探讨成人髋关节发育不良的CT分型,以指导人工全髋关节置换的手术操作。[方法]收治髋臼发育不良伴严重骨性关节炎或股骨颈骨折的Crowe I型患者63例,行双髋置换10例,术前常规行X线和三维CT明确诊断及髋臼侧和股骨侧有无畸形及程度并进行分型,根据新的分型合理设计手术方案。术后及随访X线片评价假体位置、有无移位、松动、假体周围骨折及肢体长短。[结果]平均随访3.3年,术后无切口或深部感染,无假体周围骨折及神经损伤,所有患者Harris评分由置换前的(37.9±6.9)分提高到术后近期的(91.2±2.8)分。除早期2例(占总数占2.7%)因术后脱位行二期翻修外;余71例(97.3%)经长期随访,X线示股骨柄和髋臼杯的位置以及与周围的骨质匹配整合良好。63例患者中,术前37例肢体不等长,术后34例等长,短缩<1cm 3例。[结论]对于髋臼发育不良的患者,新的CT分型,能更好的处理髋臼及股骨近端的畸形,指导选择合适的假体,获得理想的术后功能。
[ Objective ] To evaluate the outcome of total hip arthroplasty （THA） for adult acetabular dysplasia on the basis of a new preoperative CT classification. [ Methods] We reviewed 63 consecutive patients diagnosed with osteoarthritis （OA） secondary to developmental dysplasia or femoral neck fracture with developmental dysplasia who underwent THA. All joints were classified as Crowe I type and ten patients had bilateral THA. Preoperative radiographic and three -dimensional CT （3DCT） e- valuations were used to diagnose and assess hip acetabular or femoral side deformities and variations. A new preoperative classification and surgical plan were designed to rationally guide the THA. Postoperative radiographs were reviewed for prosthetic., location, migration, osteolysis, periprosthetic fracture and restoration of leg length. [ Results ] No vascular, nerve injury, periprosthetic fractures, postoperative incision or deep infection were found. The mean Harris hip scores （HHS） improved significantly from preoperative （ 37.9 ± 6. 9 ） to postoperative （ 91.2 ± 2.8 ）, with a mean follow - up of 3.3 years. Two hips （2.7% of the total） required revision for dislocations. Seventy - one hips （97.3%） were stable with signs of osseointegration af- ter a long - time follow - up. All of the patients who had equal limb lengths preoperatively had equal lengths postoperatively. Thirty - seven cases of limb length were inequality preoperatively and 34 cases achieved equal limb lengths postoperatively , including 3 cases of shortening 〈 1 cm. [ Conclusion] Mid - term outcomes for aeetabular dysplasia are good, confirming the efficacy of the new preoperative CT classification.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第1期66-70,共5页
Orthopedic Journal of China
