髋臼加深全髋置换治疗成人先天髋臼发育不良

目的：探索成人先天性髋臼发育不良伴髋关节半脱位的手术治疗方法。材料和方法：12例成人先天性髋臼发育不良伴髋关节半脱位患者采用髋臼加深髋关节置换的方法治疗。结果：经1－8年随访,段体稳定,髋关节疼痛症状消失,关节功能基本正常。结论：髋臼加深全髋关节置换是成人先天性髋臼发育不良伴髋关节半脱位的有效治疗方法。     

全髋关节置换结合打压植骨在髋臼内陷症治疗中的应用

目的 探讨全髋关节置换(THA)结合打压植骨治疗髋臼内陷症的疗效.方法 对20例髋臼内陷症行全髋关节置换,辅以非结构性打压植骨修复髋臼内侧壁缺损.手术前后记录髋关节Harris评分.结果 本组均获得随访.术前髋关节评分平均为(40.5±7.8)分,术后为(88.9±8.1)分.所有髋臼侧移植骨生长良好,术后CT提示移植骨与内陷髋臼达到骨性愈合.结论 应用自体股骨头或同种异体股骨头打压植骨填充髋臼结合多孔生物型髋臼假体治疗髋臼内陷症,疗效确切.     

全髋关节置换术治疗成人髋臼发育不良伴骨性关节炎

目的 探讨全髋关节置换术治疗成人髋臼发育不良伴骨性关节炎的临床疗效.方法 对28例(30髋)成人髋臼发育不良伴骨性关节炎行全髋关节置换术.结果 随访1～5年.术后Harris评分81～98分.2例于术后3年X线片显示人工髋臼与植骨块间有透亮区.患肢轻度跛行,其余患者人工髋臼位置均无松动.结论 全髋关节置换术能解除患者症状,改善关节功能,提高生活质量,是一种有效的治疗方法.手术成功的关键在于加深髋臼、内移髋关节活动中心及适当植骨.     

髋臼发育不良伴股骨头坏死三种全髋关节置换术式的治疗体会

目的 探讨髋臼发育不良伴股骨头坏死行全髋关节置换术的方法及临床疗效.方法 对30例髋臼发育不良伴股骨头坏死实施人工全髋关节置换术(THA),髋臼缺损采用提高旋转中心10例、患侧股骨头造盖10例、特殊髋臼钢板重建髋臼10例.结果 25例获得随访,时间1年～9年4个月,平均3.5年.术后髋关节功能Harris评分平均81.6分,下肢短缩-2～2.5 cm,平均1.0 cm.3例骨盆倾斜习惯术后未能矫正,行走时感患肢过长.结论 髋臼发育不良伴股骨头坏死术式多样,需根据髋臼的具体情况选择.     

先天性髋脱位全髋关节置换自体股骨头结构性植骨重建髋臼的应用

目的：观察自体股骨头结构性植骨在先天性髋关节脱位的全髋关节初次置换中(THR)重建髋臼缺损的临床价值。方法：1998年9月-2001年6月，对在术中应用自体股骨头结构性植骨重建髋臼的12例先天性髋关节脱位患者(congenital dislocation of the hip,CDH)作回顾性研究。其中男5例，女7例。手术时平均年龄46岁(31—66岁)。根据Hartofilakidis分型：I型2例，Ⅱ型8例，Ⅲ型2例。应用Harris评分标准及X线评价术后临床转归和植骨块愈合情况。结果：12例患者术后平均随访20个月(7—28个月)。术前Harris评分由43．6分(32—57分)增加至术后的72．8分(55—96分)。放射学显示植骨块均与骨盆愈合。2例植骨块在髋臼假体外缘出现轻度骨吸收。髋臼假体周围无放射学透亮线存在。本组患者术后无感染发生。结论：存在髋臼前外侧骨缺损的CDH患者，根据髋臼前外侧骨缺损程度选用自体股骨头结构性植骨是一种可靠而有效的方法。     

髋臼骨折内固定失败患者的全髋置换

目的探讨全髋置换对治疗髋臼骨折内固定术后失败患者的近期疗效和手术成功要素。方法对26例髋臼骨折内固定失败的患者行全髋置换。均采用K-L后外侧切口,充分显露和检查髋臼形态,3例有坐骨神经损伤者术中同时作松解,8例骨不连患者取出原有内固定后对骨不连进行处理重新内固定,18例节段性缺损者将切除的自体股骨头进行结构性植骨,2例髋臼存在巨大的结构性骨缺损,先植入防内突加强钛网支架,将股骨头咬成细骨颗粒打压植入。髋臼侧2例存在巨大的结构性骨缺损用骨水泥臼杯固定,其余为生物型固定臼杯,股骨侧均采用非骨水泥型假体。结果手术时间53~175(110±5.3)min;术中出血量500~1600(800±130)ml,输血量0~1 000(600±100)ml;术后早期无切口感染、假体脱位及坐骨神经损伤等并发症。随访17~58(29±8.6)个月,除1例伴有坐骨神经损伤的患者出现髋臼松动外,其余患者髋臼假体及股骨假体无松动及骨溶解征象。8例骨不连和18例骨缺损植骨患者均完全愈合。患者髋关节功能均获得明显改善,Harris评分为83~95(88±5.4)分,髋关节屈伸平均活动度110°±7.6°。结论全髋置换用于髋臼骨折内固定术后失败患者可以取得满意的临床效果,手术成功的关键在于建立稳定髋臼。     

Pemberton截骨联合股骨截骨治疗高位脱位型发育性髋关节脱位

目的 探讨高位脱位型发育性髋关节脱位(DDH)手术治疗的体会.方法 65例高位脱位型DDFI,测量髋臼指数、股骨颈前倾角,手术行Pemberton髂骨截骨、股骨粗隆下短缩旋转截骨.结果 髋关节脱位完全复位,髋臼指数恢复到平均21以下,股骨颈前倾角恢复到平均15.1.术后早期获得满意头臼对位,髋关节功能恢复良好.术后3个月以上出现髋关节半脱位和脱位5例,术后1年出现股骨头坏死3例.结论 高位脱位型DDH采取手术综合治疗可取得良好的效果.     

全髋关节置换术治疗髋关节发育不良的髋臼重建

目的探讨全髋关节置换术治疗髋关节发育不良过程中髋臼重建的方法及临床效果。方法1996年7月～2006年7月收治36例髋关节发育不良患者，按Crowe方法分型：Ⅰ型13例，Ⅱ型8例，Ⅲ型8例，Ⅳ型7例，所有患者均进行全髋关节置换术，术中采用自体股骨头及髂骨在髋臼周围做结构性植骨，髋臼旋转中心内移重建髋臼。术前和随访时采用摄片观察和Harris评分对髋关节功能进行评估。结果术后随访9个月～10年（平均6．3年）。所有移植骨块经X线片证实均与宿主骨愈合，无骨吸收现象，植骨块对髋臼的平均覆盖率为35％，未见假体松动，关节疼痛缓解，活动功能满意。Harris评分术前平均40．6分，术后平均90．3分，近中期随访效果良好，暂无二期翻修病例。结论采用自体股骨头及髂骨结构性植骨、髋臼旋转中心内移重建髋臼的髋关节置换术是治疗髋关节发育不良的有效方法。     

双锥面螺旋臼及加长矩型柄在髋关节翻修术中的应用

目的：评价Zweymiiller双锥面螺旋臼及加长矩形柄在人工全髋关节翻修中的临床应用效果。方法：自1996年11月～2001年1月，对55例56髋行髋关节翻修手术，男26例．女29例；年龄30～80岁，平均59岁。初次人工髋关节置换前诊断为股骨颈骨折27例，股骨头缺血性坏死22例，类风湿性关节炎2例，强直性脊柱炎3例，髋关节创伤性关节炎1例。初次行股骨头置换18例19髋，其中骨水泥固定3例3髋，非骨水泥固定15例16髋；全髋关节置换37例37髋，其中骨水泥固定25髋，非骨水泥固定12髋。术后20髋因髋关节严重疼痛、36髓因无菌性假体松动行关节翻修术。翻修手术中．16髋行髋臼植骨术，其中自体碎屑植骨15髋．异体大块植骨1髋。所有病例均使用双锥面螺旋臼及加长矩形柄系统固定。术后随访时间为5～63个月，平均31个月。结果：术后随访32例33髓．所有患者髓关节基本无疼痛，X线片示髋臼和股骨柄假体位置满意，无松动和感染征象，髋臼植骨处愈合良好。3例股骨柄假体正位X线片仅Ⅰ出现约1mm宽的透亮带，临床检查无松动迹象。Harris评分由术前的平均40.6分(10～71分)提高到术后的平均80．4分(55～97分)。结论：对于髋臼环完整需行人工髋关节翻修术的病例，使用Zweymiiller双锥面螺旋臼及加长矩形柄系统固定牢固，临床效果满意。     

结构性植骨全髋关节置换在成人高位先天性髋关节脱位中的应用

[目的]探讨结构性植骨全髋关节置换治疗成人高位先天性髋关节脱位的临床疗效。[方法]2003年8月～2006年10月,采用结构性植骨全髋置换治疗成人高位先髋脱位22例,29髋。男10例,女12例。左13例,右16例,年龄平均34.6岁(23～42岁)。临床症状主要为患髋疼痛、不稳定和跛行。术前Harris评分平均为46.8分,双下肢长度差异平均为3.8cm,股骨头脱位高度平均为3.9cm,髋关节平均活动度:屈曲66.5°,外展23.8°,外旋20.4°,内旋5.3°。术中臼杯均安装于真臼处,自体股骨头结构性植骨使臼杯完全覆盖,充分软组织松解后髋关节复位。髋臼侧选用骨水泥假体18髋、小髋臼生物型假体5髋和普通生物型髋臼6髋;股骨侧选用生物型假体10髋、普通骨水泥假体13髋、窄直柄水泥假体柄4髋和长柄骨水泥假体柄2髋。观察手术时间、出血量、关节活动度、双下肢长度差异、并发症等并进行Harris关节功能评分。[结果]本组平均手术时间95min(70～135min),出血400ml(300～650ml);伤口均一期愈合,无1例感染;术后1周X线片示假体位置良好,人工髋臼外展角平均为48.6°,前倾角平均13.2°。本组22例均获随访,随访时间平均17.6个月(10～47个月),Harris评分平均89.2分(72～93分);髋关节平均活动度:屈曲115.3°,外展44.6°,外旋49.5°,内旋26.8°。双下肢长度差异平均1.2cm,2例术后股神经麻痹,术后4个月内恢复。随访期间未见明显植骨块吸收、假体松动和脱位。[结论]结构性植骨全髋关节置换是治疗成人高位先天性髋关节脱位的一种有效方法,很大程度地改善了患者的症状、功能和外形。结构性植骨可提供良好的髋臼覆盖,恢复髋关节旋转中心高度并可保留骨盆骨量。脱位高度小于4cm经软组织充分松解后能下拉复位,不会造成股神经及坐骨神经永久性麻痹。     

Preoperative Planning for Total Hip Arthroplasty for Neglected Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) is accompanied by morphological alterations on both the acetabular and the femoral side. Total hip arthroplasty (THA) provides effective treatment in cases of neglected DDH but requires elaborate preoperative planning. To determine the morphological changes resulting from the dysplasia, the anatomic acetabular position, the height of the femur head dislocation, the height of the femur head dislocation, and the combined anteversion must all be established. In addition, a vital and complicated process of strategizing leg length balance must be conducted in cases of severe DDH. Each type of leg length discrepancy (LLD), including bony and functional and anatomical LLD, should be evaluated in the context of the presence or absence of a fixed pelvic tilt. Moreover, with severe unilateral dislocated hips, a more inferior change in the original rotational center of the hip must be accounted for. Due to these multiple morphological changes, the accurate size of the prosthesis and the cup position are difficult to predict. In comparison with other methods, CT scan‐based 3‐dimensional templating provides the best accuracy. Despite the presence of anatomic alterations, various types of acetabular and femoral prostheses have been developed to treat hip dysplasia. Both cemented and cementless cups are used in DDH cases. In DDH accompanied by insufficient acetabular bone stock, a cemented cup combined with bone graft provides a reliable treatment. Monoblock stems can be used when the combined anteversion is less than 55°, and a modular stem system when this parameter is greater than 55°. Customized stems can be designed for DDH coupled with severe proximal femoral distortion. A ceramic‐on‐ceramic bearing is considered optimal for young DDH patients.     

全髋关节置换术治疗成人发育性髋关节发育不良

目的 探讨人工全髋关节置换术(THR)在成人发育性髋关节发育不良(DDH)继发骨性关节炎中的治疗效果.方法 对26例DDH继发骨性关节炎患者行THR,其中23例中、重度骨缺损者,采用植骨修补外上方承重区骨缺损,并重建髋臼及股骨的解剖结构,合理安装假体.结果 经9个月～6年随访,患者髋关节疼痛完全消失,采用Harris关节功能评分,由术前的平均(33.8±0.7)分恢复到术后9个月时的(87.1±0.3)分.结论 DDH继发骨性关节炎采用THR是行之有效的,充分的软组织松解,重建髋臼和股骨近端的结构,假体的正确选择是手术成功的关键.     

成人发育性髋关节发育不良的全髋关节置换的治疗

对于继发有创伤性髋关节炎且临床症状明显的成人发育性髋关节发育不良(DDH)患者,人工全髋关节置换(THR)是首选治疗方法。此类患者的髋臼及股骨解剖结构的异常具有特殊性,包括髋臼浅小、股骨头较小、股骨干近端髓腔狭窄等,因此其THR也与一般的THR有很大的区别且具有很高的难度。本文主要综述了对DDH的治疗很重要的临床分型,其THR尤其是髋臼重建、股骨假体的安放等过程中的难点以及解决方法。     

Total hip arthroplasty in developmental dysplasia of the hip: Review of anatomy, techniques and outcomes

Total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH) presents many challenges to the reconstructive surgeon. The complex femoral and acetabular anatomy makes standard reconstruction technically challenging. Acetabular coverage can be improved by medialization of the component or augmentation of the deficient areas with bone graft. Femoral shortening osteotomies are considered in cases of severe dysplasia and frankly dislocated hips. Each patient's unique anatomy dictates what options of reconstruction are available. The functional outcomes of THA in DDH are generally excellent, though higher rates of mechanical failure have been reported in this group. This article reviews the anatomy, classification, technical considerations, and outcomes of THA in patients with DDH.     

Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: results at five to twelve years.

BACKGROUND: Anterolateral acetabular bone deficiency is one of the technical problems associated with total hip arthroplasty in patients with developmental hip dysplasia. The purpose of this study was to evaluate the results of one method of acetabular reconstruction for hip dysplasia-placement of an uncemented socket in conjunction with a bulk femoral head autograft. METHODS: Forty-four hips in thirty-five patients (twenty-nine female and six male; average age, thirty-nine years) with developmental hip dysplasia were treated with primary total hip arthroplasty with use of an uncemented porous-coated titanium cup fixed with screws and an autogenous bulk femoral head graft. The patients were followed clinically in a prospective fashion for five to 12.3 years (mean, 7.5 years), and radiographs were analyzed retrospectively. RESULTS: Four acetabular components were revised: two, because of severe polyethylene wear and osteolysis; one, because of aseptic loosening; and one, because of fracture of the acetabular shell. The mean Harris hip score for the unrevised hips improved from 51 points preoperatively to 91 points postoperatively. No unrevised socket had definite radiographic evidence of loosening. Forty-three of the forty-four hips had no radiographic evidence of resorption of the graft or had radiographic evidence of resorption limited to the nonstressed area of the graft lateral to the edge of the cup. CONCLUSIONS: This method of reconstruction provided reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia. We use this technique for patients with moderate anterolateral acetabular bone deficiency requiring total hip arthroplasty.     

Cementless total hip arthroplasty with femoral head bone grafting for hip dysplasia

Femoral head bone grafting was required to augment acetabular bone stock in 19 cases of hip dysplasia treated with cementless total hip arthroplasty. All acetabular grafts provided mechanical support for the cementless acetabular component. Radiographic evaluation of the fixation of the femoral components at an average of 3 years after surgery revealed an optimum appearance in all cases. All porous-coated acetabular components remained stable, but only one of six (17%) nonporous threaded acetabular components maintained stability. One threaded acetabular component has been revised for symptomatic loosening. Acetabular graft healing was suspected in 18 of 19 cases (95%). Significant graft resorption was observed only in the cases with unstable threaded acetabular components. The clinical scores were high. Cementless total hip arthroplasty with structural acetabular grafting and porous acetabular components appears to produce satisfactory short-term results.     

3D打印技术在成年发育性髋关节发育不良患者股骨柄匹配度测量中的应用

目的利用3D打印技术为成年发育性髋关节发育不良(DDH)患者股骨柄的选择提供参考。方法收集23例成年DDH患者(29髋),利用3D打印机制作全股骨模型,在同一模型中分别置入矩形柄和锥形柄髓腔锉,进行CT检查,比较两种形状股骨柄在股骨髓腔中4个位置处的匹配度。结果按照髓腔开口指数(CFI)分型,香槟型8髋,正常型11髋,烟囱型10髋。通过匹配度比较,香槟型更适合锥形柄(P<0.01),正常型在两种柄的匹配度上差异无统计学意义(P>0.05),而烟囱型与矩形柄更匹配(P<0.01)。结论通过3D打印技术,可以1∶1还原DDH患者股骨近端形态,对同一模型上模拟安装两种形状的股骨柄进行匹配度的比较,可以为人工全髋关节置换术中股骨柄的选择提供参考。     

螺旋臼全髋关节置换术治疗发育性髋关节发育不良

目的探讨使用螺旋臼假体治疗发育性髋关节发育不良（DDH）继发骨性关节炎患者的临床疗效。方法自2003年5月至2007年12月，使用Zweymaller螺旋臼假体治疗40例（43髋）DDH继发骨性关节炎患者，其中男6例（6髋），女34例（37髋），平均年龄47．6岁（22～70岁）；单侧37例，双侧3例；Crowe分型：Ⅰ级6例，Ⅱ级24例，Ⅲ级10例，Ⅳ级3例。平均随访24．6个月，术前Harris评分最高61分，最低22分，平均43．5分。结果所有患者术后疼痛基本消失，双下肢长度差异平均1．2cm，2例术后出现股神经损伤症状，术后6个月症状基本消失，Harris评分最高97分，最低62分，平均85．3分。结论使用Zweymtiller螺旋臼假体治疗DDH继发骨性关节炎的患者，可以达到良好的恢复关节功能的临床疗效，手术不需大块植骨和骨水泥，初期临床效果满意。     

关节置换加自体股骨头移植治疗髋关节发育不良

目的：探讨关节置换加自体股骨头移植治疗髋关节发育不良。方法：自1995-2000年用关节置换加自体股骨头移植治疗髋关节发育不良40例(36例病人)，术前放射学评价髋关节发育不良的严重程度，术后随访分析移植物对假体的覆盖率、松动及移植物的固定情况。本组病人平均年龄44岁。术后移植的股骨头覆盖平均占髋臼28％。结果：随访2～7年，所有骨移植均融合，22例移植骨有部分吸收，但均在覆盖假体外上边缘，假体无移位。全部病例无疼痛或仅有轻度不适。结论：关节置换加自体股骨头移植是治疗髋臼不良的有效方法之一。     

采用计算机辅助技术精确实施全髋关节置换术治疗成人发育性髋脱位

目的评价采用计算机辅助技术精确实施全髋关节置换术治疗成人发育性髋脱位的价值。方法对12例12髋成人发育性髋脱位患者行薄层CT扫描及三维重建,术前模拟手术,制定手术方案,所有病例均采用全髋关节置换术。结果 12例患者均获得3～31个月术后随访,平均随访10.8月。术前Harris评分为（35.2±4.5）分,随访时评分为（89.5±5.3）分,差异有统计学意义（t=26.38,P〈0.01）。优5例,良7例。术后患肢短缩畸形、跛行步态明显改善。X线片提示所有病例均显示髋臼假体位于真臼位置,与周围骨床结合紧密。并发症：术后1例出现坐骨神经损伤,1例股骨假体下沉。结论采用计算机辅助技术精确全髋关节置换术治疗成人发育性髋脱位,疗效优良,能达到个体化治疗水平。