成人髋臼发育不良行全髋关节置换术中重建外旋肌群的作用

目的探讨对成人髋臼发育不良（DDH）采用髋关节后外侧切口行全髋关节置换术（THA）时重建外旋肌群对于预防后脱位的作用。方法自2006-01—2012—06对57例（64髋）成人DDH行初次THA,术中于股骨粗隆外旋肌群附着处用克氏针钻孔。将外旋肌群用可吸收缝线缝合至股骨大粗隆（重建组）。将重建组THA术后脱位率与同期成人DDH行THA但不重建外旋肌群（对照组）55例（62髋）的脱位率进行比较分析。结果术后6个月内,重建组仅1髋（1．6％）发生术后早期脱位．对照组则有4髋（6．5％）发生早期脱位,2组髋关节早期脱位率差异有统计学意义（P〈0．05）。6个月以后,2组均未发生迟发性脱位。2组末次随访时Harris评分比较,差异无统计学意义（P〉0．05）;但2组末次随访时Harris评分均较术前明显提高,差异有统计学意义（P〈0．05）。结论采用后外侧切口对成人DDH行THA治疗时重建外旋肌群技术能够有效预防术后早期脱位。     

Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia

Background:Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique.Results:The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections.Conclusion:Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.     

全髋置换术治疗髋关节发育不良

目的探讨全髋置换术治疗髋关节发育不良(DDH)的手术方法并评价其临床疗效。方法12例DDH患者根据Crowe分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型4例,Ⅳ型2例。全部采用B iom et全髋假体置换。髋臼假体均为生物型固定,股骨假体除2例骨水泥固定,其余为生物型固定。3例髋臼重建利用自体股骨头于髋臼前外方植骨造盖,9例于真臼水平将髋臼内移;3例股骨重建于转子下截骨短缩并纠正前倾;Ⅲ、Ⅳ型DDH行关节周围软组织松解。结果患者术后均未出现坐骨神经麻痹、下肢深静脉栓塞、切口感染及早期人工关节脱位等并发症。肢体延长最多4.8 cm,平均2.8 cm。随访6个月~2年,Harris髋关节评分由术前平均40.7分提高到84.5分,未发生人工关节脱位或假体松动。结论对有症状的DDH或强烈要求改善步态的年轻患者,全髋置换术是一种有效的治疗方法。     

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.     

髋关节发育不良的严重程度与骨水泥型全髋关节置换术后髋臼假体松动的相关性

目的探讨在骨水泥型全髋关节置换术髋臼假体的术后生存率和髋关节发育不良（development dysplasia of the hip,DDH）严重程度的相关性。方法应用骨水泥型全髋关节置换术治疗DDH合并创伤性髋关节炎患者92例103髋,女85例96髋,男7例7髋;年龄39～78岁,平均47．2岁。根据Crowe分级：42例46髋为Ⅰ度,21例24髋为Ⅱ度,16例18髋为Ⅲ度,13例15髋为Ⅳ度。49例56髋采用改良Gibson人路,43例47髋经直接外侧I-Iar-dinge人路。46例48髋使用自体股骨头进行髋臼骨移植,所有移植的骨块均用松质骨螺钉或Kirschner钢丝固定于髋臼上。进行骨移植的适应证主要是髋臼组成部分的上方未取得足够骨覆盖。结果62例76髋获得随访,随访时间2～19年,平均98个月。将因无菌性松脱而行髋臼翻修作为观察终点,10年随访髋臼假体生存率为86．8％～94．4％,平均90．6％;18年随访生存率为53．9％～72．O％,平均63．0％。结论随着髋臼发育不良严重程度的加重,随访年后骨水泥型髋臼假体有更高的失败率。     

不同程度髋关节发育不良继发骨性关节炎的全髋关节置换术疗效分析

[目的]探讨全髋关节置换术治疗髋关节发育不良继发骨性关节炎的术后效果及髋关节发育不良的严重程度对于术疗效的影响.[方法]对47例(55髋)髋关节发育不良继发骨性关节炎的患者进行全髋关节置换术.其中Crowe Ⅰ型23髋;Ⅱ型19髋;Ⅲ/Ⅳ型共13髋.术前应用影像学方法评估髋臼和股骨的形态学变化,术中髋臼重建在真臼位置,逐渐扩大股骨髓腔,选用细而直的股骨假体.术前和术后对术侧髋关节行Harris髋关节评分.[结果]Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者Harris髋关节评分分别由术前的50.7±7.6、44.9±6.2和41.1±8.2增加到术后的90.6±3.7、87.3±4.5和82.7±7.3,和术前比较有显著性差异(P＜0.05).Harris髋关节评分分级显示,Ⅰ、Ⅱ和Ⅲ/Ⅳ型髋关节术后分级在良以上的关节分别占本组髋关节的100%、100%和69%,优分别为70%、53%和31%.随访23～81个月,平均45个月,关节假体稳定,关节功能正常.[结论]全髋关节置换术是治疗髋关节发育不良继发骨性关节炎的有效方法,Crowe Ⅰ和Ⅱ型患者术后效果优于Ⅲ/Ⅳ型.     

髋臼加盖技术行全髋关节置换术治疗发育性髋脱位

目的探讨髋臼加盖技术行生物型全髋关节置换术(THA)治疗发育性髋脱位(DDH)的临床疗效。方法采用髋臼加盖技术行生物型THA治疗30例DDH患者(30髋),观察手术前后双下肢长度差异、髋关节旋转中心高度和水平距离、移植骨块与髂骨融合时间,记录术后骨溶解、骨长入、臼杯松动情况,采用Harris髋关节评分(HHS)评价手术疗效。结果患者均获得随访,时间24~60(38.8±16.9)个月。双下肢长度差异由术前11~55(25.3±17.2)mm下降到术后0~12(3.7±3.5)mm(P<0.001),髋关节旋转中心高度由术前35~65(46.1±16.7)mm下降到术后18~30(23.7±5.9)mm(P<0.001),髋关节旋转中心水平距离由术前35~55(42.8±8.9)mm下降到术后18~29(23.3±2.7)mm(P<0.001)。移植骨块与髂骨融合时间5~12(7.7±4.9)个月。HHS由术前39~65(41.8±14.8)分提高到末次随访时84~100(93.5±7.9)分(P<0.001)。至末次随访,无一例出现假体周围骨溶解,假体均获得骨长入固定。结论采用髋臼加盖技术行生物型THA治疗DDH,可获得满意临床疗效。     

全髋关节置换术治疗成人髋关节发育不良

目的 探讨全髋关节置换术(THA)治疗成人髋关节发育不良的临床疗效.方法 采用THA治疗45例髋关节发育不良患者(50髋).记录术后感染、髋关节脱位、假体松动、神经损伤情况,末次随访时采用Harris评分评定髋关节功能.结果 患者均获得随访,时间2～65(24.1±16.0)个月.术后无感染、髋关节脱位、神经损伤等并发...     

全髋置换术治疗髋关节发育不良

目的探讨髋关节发育不良(DDH)全髋关节置换术的临床方法与疗效。方法对48例DDH继发骨性关节炎的患者(56髋)进行全髋关节置换术。其中CroweⅠ型24髋,Ⅱ型19髋,Ⅲ/Ⅳ型13髋。术前应用影像学方法评估髋臼和股骨的形态学变化。手术采用常规髋关节置换术,恢复髋关节旋转中心35例(40髋),采用自体股骨头结构性植骨重建髋臼旋转中心6例(8髋),髋臼假体内置5例(6髋),高位重建髋臼2例(2髋)。结果 48例均获得随访,时间3个月～8年。关节假体稳定,关节功能正常,双下肢短缩均有明显改善,未出现感染、脱位、神经损伤并发症。Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者按Harris髋关节评分,分别由术前的(47.3±6.5)分、(42.7±5.5)分和(38.6±7.8)分增加到术后的(92.4±4.1)分、(88.2±4.7)分和(83.9±6.6)分,与术前比较差异有统计学意义(P<0.05)。结论对成人DDH按照Crowe分型采用不同方法行全髋关节置换,是一种可靠而有效的方法。充分的软组织松解、重建髋臼和股骨近端的结构以及正确选择假体是手术成功的关键。     

Evaluation of the hip center in total hip arthroplasty for old developmental dysplasia

We describe the problems with positioning the hip center according to the severity of dislocation in 97 cementless total hip arthroplasty for developmental dysplasia of the hip. The mean location of the hip center from the interteardrop was 30.4 +/- 8.7 mm horizontally and 23.4 +/- 5.4 mm vertically. The presence of a limp correlated with a superior placement of the cup. Four cups were revised, 2 of which with a significant high hip center. The survival rate of the acetabular component was 95% at 12 years. Craniopodal repositioning was easy in class 1. In class 2, the cup was the largest. In class 3, the greatest variations of the hip center were found. In class 4, the smallest implants were necessary for positioning in the true acetabulum.     

Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip

Introduction Total joint replacement in patients suffering from developmental dysplasia of the hip poses specific technical difficulties due to insufficient bone stock at the site of the original and secondary acetabulum and a narrow, cranially displaced proximal femur.Materials and methods Twelve hips with severe congenital dislocation (4 Crowe type II, 5 type III, 3 type IV) were treated with cementless, porous structured total hip replacement. The cup was implanted at the anatomic height, a femoral segment was resected below the minor trochanter to reduce the femoral component in all cases.Results One femoral component was exchanged for a longer stem after 2 months due to insufficient fit and fill. After a mean follow-up of 5.1 years, there were no further revisions or radiographic signs of loosening. No cup was revised or loose radiographically. Harris hip score (mean) improved from 36 to 82 points, mean leg length discrepancy was reduced from 5.4 to 1.3 cm.Conclusion The cementless technique described is useful in cases of severe congenital dislocation of the hip when the cup is implanted at the anatomic level, and implant reduction is not possible despite thorough soft-tissue release or not advisable because of excessive limb lengthening. A reconstruction of the original joint center and good mid-term results are demonstrated.     

全髋关节置换术治疗成人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成人髋关节发育不良（DDH）时不同方式髋臼重建对疗效的影响。方法 2000年1月至2007年10月,36例（44髋）先天性髋臼发育不良患者进行了全髋关节置换。年龄42～65岁,平均48岁。术前Harris评分平均为49.9分,双下肢长度差异平均为1.8 cm,髋关节平均活动度：屈曲59.6°,外展21.6°,内收13.9°,外旋10°,内旋8.2°。术中臼杯均安装于真臼处,髋臼内移14髋,髋臼内陷成形术18髋,自体股骨头结构性植骨12髋。髋臼侧均选用非骨水泥型假体。疗效评价：根据Harris评分分为优、良、可、差四级。结果所有患者均获得随访,随访时间1.8～9.2年,平均5.1年。平均Harris评分由术前的49.9分恢复到术后的90.1分,两者比较有统计学差异（P〈0.01,t=28.807）,其中评定为优23髋、良17髋、可4髋,术后优良率达90.9%。术后髋关节平均活动度：屈曲105°,外展35°,内收15.8°,外旋45°,内旋15°。本组病例无肺栓塞、深静脉血栓形成、感染等并发症发生。X线检查示假体无松动移位,无翻修病例。结论全髋关节置换术治疗成人髋臼发育不良采用恰当的髋臼重建结合非骨水泥型髋臼假体可获得满意中远期疗效。     

Primary total hip arthroplasty in severe developmental dysplasia of the hip. Ten-year results using a cementless modular stem

We report the average 10-year clinical and radiographic results of 28 hips with Crowe III or IV developmental dysplasia of the hip (DDH) and a technically difficult primary hip arthroplasty using the cementless modular S-ROM stem (DePuy Orthopedics, Warsaw, Ind). Twenty-one patients required significant autologous bone grafting, 1 had a large allograft, and 6 patients required femoral shortening at the time of their total hip arthroplasty. Three patients had an intraoperative technical complication. The average preoperative Harris hip score was 37; at 10 years, 81. The Short Form 12 was 41.64 physical/54.03 mental at 10 years, and the WOMAC average score was 23 at 10 years. None of the S-ROM stems had been revised or were loose at latest follow-up. Six hips had osteolysis in Gruen zones 1 or 7 but none around or distal to the sleeve. The 10-year results of the S-ROM stem used in patients with osteoarthritis secondary to severe DDH are excellent.     

Early results of total hip arthroplasty in patients with developmental dysplasia of the hip compared with patients with osteoarthritis

We have investigated the results of primary total hip arthroplasty (THA) performed in patients with developmental dysplasia of the hip (DDH). Through the New Zealand Joint Registry, we identified all patients with DDH undergoing primary THA (n = 1205) and all patients with primary osteoarthritis (OA) undergoing primary THA (n = 40 589) between January 1, 1999, and December 31, 2008. Postoperative outcomes, baseline information, and operative characteristics were analyzed and compared between the DDH and the OA groups. There was no significant difference in Oxford Hip Score or revision rate between the 2 groups. Our results support THA as a successful surgical option in the management of degenerative arthritis in DDH, with comparable functional outcomes and revision rates to THA performed for primary OA.     

应用组配式S-ROM假体行初次全髋关节置换术治疗严重髋关节发育不良

[目的]探讨应用非骨水泥型组配式S-ROM假体行初次全髋关节置换术治疗严重髋关节发育不良的近期疗效。[方法]对18例(19髋)严重髋关节发育不良患者应用S-ROM假体行初次全髋关节置换术。其中男性6例,女性12例,平均年龄32岁。按Crowe分型,CroweⅢ型11例11髋,CroweⅣ型7例8髋。手术采用在真臼位置磨锉加深重建髋臼,股骨侧选用S-ROM组配式假体,复位困难者行转子下截骨。术前和术后随访时应用Harris髋关节评分(Harris hip score,HHS)和影像学检查对髋关节功能进行评估。[结果]术中1例股骨近端裂缝骨折,用双股钢丝环扎固定。术后有2例出现坐骨神经牵拉症状,术后3个月内完全恢复。所有患者均得到有效随访,有1例患者大转子上方发生异位骨化,但不影响关节活动度,未发现感染、骨质溶解、假体松动、脱位等并发症。平均随访2.8年(6个月~5年)。HHS评分由术前平均38.4分增加到末次随访时的85.2分。[结论]S-ROM假体是治疗严重髋关节发育不良的理想选择,近期效果良好。     

Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip

The precise relationship between developmental dysplasia of the hip and dislocation among patients after total hip arthroplasty has not been well clarified. A total of 820 patients with developmental dysplasia of the hip who underwent total hip arthroplasty from January 2000 to December 2009 were categorized according to Crowe classification, and postoperative dislocation rates were analyzed among subgroups. The overall dislocation rate was 2.93%. No statistically significant differences in dislocation rates were observed between these with and without subtrochanteric osteotomy. Femoral head size was the only factor with significant difference between the dislocated and stable groups, especially when femoral head diameter increased from 28 to 32 mm. Of all dislocations, 69.6% were anterior dislocation, and the degree of cup anteversion and combined anteversion of anterior dislocators was higher than that of the posterior dislocators (P = .0082 and P = .001).     

联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中的应用

目的探讨联合前倾角技术在成人发育性髋关节发育不良全髋关节置换术中应用的可行性及临床价值。方法回顾性分析自2016-09—2018-06采用联合前倾角技术行全髋关节置换术治疗的31例(36髋)成人发育性髋关节发育不良,比较手术前后髋臼前倾角、股骨前倾角、联合前倾角及髋关节功能Harris评分。结果31例均获得12个月以上随访。术后骨盆正位及髋关节侧位X线片显示假体位置及对应关系良好,无假体松动、下沉,无脱位表现。末次随访时所有患者步态均明显改善,髋部疼痛均消失,仅2例轻度跛行。术后髋臼前倾角、股骨前倾角、联合前倾角较术前明显减小,末次随访时髋关节功能Harris评分较术前明显增加,差异有统计学意义(P<0.05)。结论联合前倾角技术应用于成人发育性髋关节发育不良全髋关节置换术对于指导合适假体的选择、设计以及确定合适的髋臼前倾角、股骨柄前倾角具有重要意义,良好的联合前倾角能够有效预防术后假体脱位的发生。     

成人髋关节发育不良全髋关节置换术后外展肌功能的变化

目的评估成人髋关节发育不良全髋关节置换术（THA）术后外展肌的变化,为术后康复训练提供一定的理论依据。方法 THA治疗成人单侧髋关节发育不良19例,分别在术前、术后2周、1、3、6、12个月进行髋关节Harris评分和Trendelenburg试验;并测定术后患侧与健侧髋关节外展最长持续时间。结果双下肢短缩差异值由术前平均29.2mm（范围15.9-45.0mm）缩小至术后平均2.5mm（范围-6.7-8.8mm）,术后Harris评分、患侧与健侧髋关节外展最长持续时间数据比与术后时间呈正相关,且以1-6个月之内变化最为明显,6-12个月变化趋势变缓;术后3个月Trendelenburg试验阳性6例,术后12个月随访Trendelenburg试验阳性4例。结论成人髋关节发育不良患者外展肌功能在THA术后1～6个月之间恢复最快,6～12个月恢复趋势变缓。     

全髋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髋臼发育不良(DDH)伴髋关节骨性关节炎的手术疗效.方法 对11例(12髋)因DDH致髋关节骨性关节炎患者行全髋关节置换术.根据Zionts分级,Ⅰ度7髋,Ⅱ度5髋.术前Harris评分28～63(48.1±9.4)分.结果 11例均获随访,时间6个月～6年.术后Harris评分为82～98(88.6±7.6)分.1例术后3年X线片示人工臼与植骨块间有透亮线,余患者人工臼位置均无移位、松动.有2例患肢轻度跛行,无疼痛,可以长距离行走.结论 全髋置换术解除患者症状,改善关节功能,提高生活质量,是一种行之有效的治疗方法.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.