全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎
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摘要
目的：本研究的目的在于评价短柄人工关节置换治疗Crowe Ⅰ和Ⅱ型成人发育性髋关节发育不良继发骨性关节炎的早期临床效果。
方法：2007年10月-2012年8月,12位Crowe Ⅰ和Ⅱ型发育性髋关节发育不良继发骨性关节炎的患者(共18髋)在我科行短柄人工关节置换术,他们的平均年龄是38.7岁(从29-46岁)。其中男性4位,占33.3%；女性8位,占66.7%。术前术后做好详细的临床体检记录并对比影像学资料。随访记录时问从术后第6周开始,术后第3,6,9个月随访,然后每年一次随访。
结果：所有患者平均随访时间为24个月(6-48个月)。随访期间,并没有任何诸如髋关节脱位,假体周围骨折,感染等并发症的发生。就临床观察而言,Harris评分从术前的平均44±6.28提高至术后的平均91±5.26。患者疼痛症状基本消失,术后三个月即弃拐行走,髋关节活动度明显改善。随访拍片的资料显示并没有任何假体出现假体松动。对于单侧DDH合并肢体不等长的患者,术前下肢不等长平均差值在1.2cm (0.8-1.7cm)。术后基本矫正,下肢不等长在均控制在0.5cm以内。
结论：短柄人工关节置换对于年轻有活力的Crowe Ⅰ和Ⅱ型成人发育性髋关节发育不良继发骨性关节炎患者是一种良好的选择。
目的本研究的目的在于回顾性的分析骨外固定延长器肢体延长后全髋关节置换(THA)治疗年轻Crowe Ⅳ型发育性髋关节发育不良(DDH)继发骨性关节炎的方法与疗效,并解决全髋置换术后肢体不等长的问题。
方法2007年10月至2012年1月,我科收治了12例单侧Crowe Ⅳ型DDH继发骨性关节炎的患者,男2例,女10例；平均年龄25.7岁(18-35岁)。采取分次手术的方法,首次手术行软组织松解和肢体外固定延长器延长。术中即行延长1-2cm,术后每天延长3-5mm,耗时10-17天。纠正肢体短缩即股骨头下移至真臼水平后行再次手术THA。术中采用生物型假体结合自体股骨头移植重建髋臼。所有手术均不需行股骨短缩截骨。
结果平均随访13.6个月,无一例出现钉道感染,髋关节感染,假体松动及神经损伤。术前肢体不等长平均5.6cm,术后肢体不等长平均0.5cm。Harris评分由术前的45.7±2.59提高到术后的92.3±3.26,差异有统计学意义。
结论针对年轻的Crowe Ⅳ型DDH继发骨性关节炎患者,下肢不等长>5cm的病例,在THA术前通过髂股牵引接近完全的恢复肢体长度,纠正下肢不等长；同时采取逐步延长的方式避免了神经损伤。因此,不需要采取股骨短缩截骨的方式将假体置入真臼的旋转中心水平并获得良好的复位。
Objective The aim of this study was to evaluate the early clinic outcome of short-stem total hip arthroplasty for osteoarthritis secondary to the Crowe type I and II developmental dysplasia of the hip (DDH) cases.
Methods Between October2007and August2012, twelve consecutive patients (eighteen hips) with the diagnosis of osteoarthritis secondary to Crowe type I and II DDH underwent short-stem total hip arthroplasty. Their average age at the time of surgery was38.7years (range,29-46years). Four patients (33.3%) were male and eight (66.7%) were female. Clinical and radiographic results were recorded before and after operation. The times of follow-up were performed at6weeks,3,6,9months and then once a year.
Results All patients were followed for a mean time of24months (6-48months). During the follow-up period, no such complications as dislocation, fracture or infection occurred. As to the clinical outcomes, according to the Harris hip score, improved significantly from44±6.28score preoperatively to91±5.26postoperatively. In addition to the pain completely relieved, the range of hip motion was remarkably improved and no restriction was needed3months after operation.The radiographic analysis in the follow-up showed that all prostheses were fixed with no radiolucencies. For the patients who were unilateral DDH with preoperative limb-length discrepancy (LLD) from0.8to1.7cm, all regained almost equal limb length postoperatively, the LLD was under0.5cm.
Conclusions The short-stem total hip arthroplasty may be a reasonable option for osteoarthritis secondary to the Crowe types Ⅰ and Ⅱ DDH, who were young and active.
Objective To retrospectively analyze the methods and clinical outcome of treatment on Crowe type IV DDH (developmental dysplasia of the hip)in young adults with THA (total hip arthroplasty) and limb-lengthing external fixator.
Methods From Oct2007to Jan2012, twelve patients(2male and10female) with unilateral Crowe type IV DDH were adimtted into our department. The mean age was25.7years old (18-35years old). We adopted two-staged surgical method, in the first stage, the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for10-17days. There were1-2cm distraction at the first time and3-5mm daily distraction. When the femoral bead was distracted to the level of anatomical position, the second stage—THA was used. In the second stage, all patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction. The acetabular cup was placed in the anatomical position in every patient. Shortening femoral osteotomies were not required.
Results The average follow-up was13.6months, no patient had a pin-site infection, hip joint infection, prosthesis loosening or nerve injury. Limb-length discrepancy was5.6cm on average preoperatively and0.5cm on average postoperatively. The Harris hip score was increased from45.7±2.59preoperatively to92.3±3.26postoperatively, the difference was statistically significant.
Conclusion For the Crowe type Ⅳ DDH in young adults, we could restore nearly normal limb length and avoid nerve injury via continuously limb-lengthing by external fixator before THA. Therefore, we were able to safely place the acetabular cup at the anatomical position without femoral shortening.
方法：2007年10月-2012年8月,12位Crowe Ⅰ和Ⅱ型发育性髋关节发育不良继发骨性关节炎的患者(共18髋)在我科行短柄人工关节置换术,他们的平均年龄是38.7岁(从29-46岁)。其中男性4位,占33.3%；女性8位,占66.7%。术前术后做好详细的临床体检记录并对比影像学资料。随访记录时问从术后第6周开始,术后第3,6,9个月随访,然后每年一次随访。
结果：所有患者平均随访时间为24个月(6-48个月)。随访期间,并没有任何诸如髋关节脱位,假体周围骨折,感染等并发症的发生。就临床观察而言,Harris评分从术前的平均44±6.28提高至术后的平均91±5.26。患者疼痛症状基本消失,术后三个月即弃拐行走,髋关节活动度明显改善。随访拍片的资料显示并没有任何假体出现假体松动。对于单侧DDH合并肢体不等长的患者,术前下肢不等长平均差值在1.2cm (0.8-1.7cm)。术后基本矫正,下肢不等长在均控制在0.5cm以内。
结论：短柄人工关节置换对于年轻有活力的Crowe Ⅰ和Ⅱ型成人发育性髋关节发育不良继发骨性关节炎患者是一种良好的选择。
目的本研究的目的在于回顾性的分析骨外固定延长器肢体延长后全髋关节置换(THA)治疗年轻Crowe Ⅳ型发育性髋关节发育不良(DDH)继发骨性关节炎的方法与疗效,并解决全髋置换术后肢体不等长的问题。
方法2007年10月至2012年1月,我科收治了12例单侧Crowe Ⅳ型DDH继发骨性关节炎的患者,男2例,女10例；平均年龄25.7岁(18-35岁)。采取分次手术的方法,首次手术行软组织松解和肢体外固定延长器延长。术中即行延长1-2cm,术后每天延长3-5mm,耗时10-17天。纠正肢体短缩即股骨头下移至真臼水平后行再次手术THA。术中采用生物型假体结合自体股骨头移植重建髋臼。所有手术均不需行股骨短缩截骨。
结果平均随访13.6个月,无一例出现钉道感染,髋关节感染,假体松动及神经损伤。术前肢体不等长平均5.6cm,术后肢体不等长平均0.5cm。Harris评分由术前的45.7±2.59提高到术后的92.3±3.26,差异有统计学意义。
结论针对年轻的Crowe Ⅳ型DDH继发骨性关节炎患者,下肢不等长>5cm的病例,在THA术前通过髂股牵引接近完全的恢复肢体长度,纠正下肢不等长；同时采取逐步延长的方式避免了神经损伤。因此,不需要采取股骨短缩截骨的方式将假体置入真臼的旋转中心水平并获得良好的复位。
Objective The aim of this study was to evaluate the early clinic outcome of short-stem total hip arthroplasty for osteoarthritis secondary to the Crowe type I and II developmental dysplasia of the hip (DDH) cases.
Methods Between October2007and August2012, twelve consecutive patients (eighteen hips) with the diagnosis of osteoarthritis secondary to Crowe type I and II DDH underwent short-stem total hip arthroplasty. Their average age at the time of surgery was38.7years (range,29-46years). Four patients (33.3%) were male and eight (66.7%) were female. Clinical and radiographic results were recorded before and after operation. The times of follow-up were performed at6weeks,3,6,9months and then once a year.
Results All patients were followed for a mean time of24months (6-48months). During the follow-up period, no such complications as dislocation, fracture or infection occurred. As to the clinical outcomes, according to the Harris hip score, improved significantly from44±6.28score preoperatively to91±5.26postoperatively. In addition to the pain completely relieved, the range of hip motion was remarkably improved and no restriction was needed3months after operation.The radiographic analysis in the follow-up showed that all prostheses were fixed with no radiolucencies. For the patients who were unilateral DDH with preoperative limb-length discrepancy (LLD) from0.8to1.7cm, all regained almost equal limb length postoperatively, the LLD was under0.5cm.
Conclusions The short-stem total hip arthroplasty may be a reasonable option for osteoarthritis secondary to the Crowe types Ⅰ and Ⅱ DDH, who were young and active.
Objective To retrospectively analyze the methods and clinical outcome of treatment on Crowe type IV DDH (developmental dysplasia of the hip)in young adults with THA (total hip arthroplasty) and limb-lengthing external fixator.
Methods From Oct2007to Jan2012, twelve patients(2male and10female) with unilateral Crowe type IV DDH were adimtted into our department. The mean age was25.7years old (18-35years old). We adopted two-staged surgical method, in the first stage, the patients underwent soft tissue relaxation and iliofemoral distraction with use of an external fixator for10-17days. There were1-2cm distraction at the first time and3-5mm daily distraction. When the femoral bead was distracted to the level of anatomical position, the second stage—THA was used. In the second stage, all patients underwent uncemented prosthesis with bulk femoral head autograft for acetabular reconstruction. The acetabular cup was placed in the anatomical position in every patient. Shortening femoral osteotomies were not required.
Results The average follow-up was13.6months, no patient had a pin-site infection, hip joint infection, prosthesis loosening or nerve injury. Limb-length discrepancy was5.6cm on average preoperatively and0.5cm on average postoperatively. The Harris hip score was increased from45.7±2.59preoperatively to92.3±3.26postoperatively, the difference was statistically significant.
Conclusion For the Crowe type Ⅳ DDH in young adults, we could restore nearly normal limb length and avoid nerve injury via continuously limb-lengthing by external fixator before THA. Therefore, we were able to safely place the acetabular cup at the anatomical position without femoral shortening.
引文
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