摘要
目的探讨侧卧位直接前方入路(direct anterior approach,DAA)自体股骨头髋臼结构性植骨人工全髋关节置换术(total hip arthroplasty,THA)治疗CroweⅢ、Ⅳ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的可行性及临床疗效。方法2016年6月—2020年7月,采用侧卧位DAA自体股骨头髋臼结构性植骨THA治疗12例(12髋)CroweⅢ、Ⅳ型DDH患者。男2例,女10例;年龄50~79岁,平均60.2岁。Crowe分型为Ⅲ型10髋、Ⅳ型2髋。术前髋关节Harris评分为(48.8±7.5)分,双下肢长度差异(3.0±0.7)cm,活动时疼痛视觉模拟评分(VAS)为(7.2±0.9)分。记录手术切口长度、手术时间、术中出血量、并发症情况;术后观察髋臼、股骨假体位置及压配情况,测量双下肢长度差异变化;测量髋臼杯水平覆盖率,植骨块与宿主骨愈合情况、假体有无松动;采用Harris评分评估髋关节功能,VAS评分评估患者活动时疼痛情况。结果手术切口长度平均9.3 cm,手术时间平均117 min,术中出血量平均283 mL。术中2例患者(16.7%)予以输血。术中无髋臼及股骨骨折;术后切口均Ⅰ期愈合,无脱位、假体周围感染、坐骨神经损伤、下肢深静脉血栓形成等并发症发生;术后1例出现股外侧皮神经损伤症状。出院时复查X线片示髋臼杯水平总覆盖率为93%~100%,平均97.8%;髋臼杯植骨块水平覆盖率为25%~45%,平均31.1%。12例患者均获随访,随访时间22~71个月,平均42.2个月。末次随访时,髋关节Harris评分为(89.7±3.9)分,双下肢长度差异为(0.9±0.4)cm,活动时VAS评分为(1.1±0.6)分,与术前比较差异均有统计学意义(P<0.05)。随访期间无1例患者因假体松动需行髋关节翻修手术。末次随访时植骨块和宿主骨之间无透亮线、已融合,位置良好,未见明显移动。其中1例患者植骨块的1枚螺钉断裂合并植骨块外缘骨吸收,但植骨块未移位且愈合良好。结论侧卧位DAA自体股骨头髋臼结构性植骨THA治疗CroweⅢ、Ⅳ型DDH安全可靠,近期疗效满意。
Objective To explore the feasibility and effectiveness of total hip arthroplasty(THA)with acetabulum structural bone grafting using autogenous femoral head through direct anterior approach(DAA)in lateral decubitus position in the treatment of Crowe typeⅢandⅣdevelopmental dysplasia of the hip(DDH).Methods Between June 2016 and July 2020,12 patients with Crowe typeⅢandⅣDDH were treated with THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position.There were 2 males and10 females with an average age of 60.2 years(range,50-79 years).Crowe classification was typeⅢin 10 hips and typeⅣin2 hips.The preoperative Harris score of hip joint was 48.8±7.5,the difference in length of both lower extremities was(3.0±0.7)cm,and the visual analogue scale(VAS)score during activity was 7.2±0.9.The surgical incision length,operation time,intraoperative blood loss,and complications were recorded;the position and press-fitting of acetabulum and femoral prosthesis were observed after operation,and the difference in length of both lower extremities was measured;the horizontal coverage of acetabular cup and bone graft were measured,the healing with the host bone and the loosening of the prosthesis were evaluated;Harris score was used to evaluate hip joint function,and VAS score was used to evaluate patients’pain during activity.Results The average surgical incision length was 9.3 cm,the average operation time was 117 minutes,and the average intraoperative blood loss was 283 mL.Two patients(16.7%)received blood transfusion during operation.There was no acetabular and femoral fractures during operation.All incisions healed by first intention,without dislocation,periprosthetic infection,sciatic nerve injury,deep venous thrombosis,and other complications.One patient had lateral femoral cutaneous nerve injury after operation.X-ray films at discharge showed a total acetabular cup level coverage of 93%-100%,with an average of 97.8%,and a bone graft level coverage of 25%-45%,with an average of 31.1%.All the 12 patients were followed up 22-71 months,with an average of 42.2 months.At last follow-up,the Harris score of hip joint was 89.7±3.9,the difference in length of both lower extremities was(0.9±0.4)cm,and the VAS score during activity was 1.1±0.6,which were significantly different from those before operation(P<0.05).During follow-up,there was no patient who needed hip revision surgery because of prosthesis loosening.At last follow-up,there was no translucent line between the graft and the host bone,the graft was fused,the position was good,and there was no obvious movement.One patient had one screw fracture and bone resorption at the outer edge of the graft,but the bone graft did not displace and healed well.Conclusion THA with acetabulum structural bone grafting using autogenous femoral head through DAA in lateral decubitus position in the treatment of Crowe typeⅢandⅣDDH is safe and reliable,and has satisfactory short-term effectiveness.
作者
裴立家
周新社
吴一凡
刘扬
薛亚东
孟繁宇
刘犇
PEI Lijia;ZHOU Xinshe;WU Yifan;LIU Yang;XUE Yadong;MENG Fanyu;LIU Ben(Department of Orthopedics,the First Afiliated Hospital of Bengbu Medical College,Anhui Osteoarthritis Diagnosis and Treatment Center,Anhui Key Laboratory of Tissue Transplantation,Bengbu Anhui,233000,P.R.China;Department of Orthopedics,Suzhou Afliated Hospital of Anhui Medical University,Suzhou Anhui,234099,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第9期1084-1089,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
蚌埠医学院自然科学基金重点项目(BYKY2019030ZD)。
