应用S-ROM全髋关节置换术治疗Crowe Ⅳ型髋臼发育不良

目的总结采用粗隆下截骨和生物固定型带股骨柄模块的人工关节假体治疗CroweⅣ型髋臼发育不良伴骨关节炎的效果及经验。方法回顾从2004年2月到2009年4月对12例21髋CroweⅣ型髋臼发育不良伴骨关节炎患者治疗的详细过程及疗效,记录所有的并发症。全部采用粗隆下截骨和S-ROM生物固定型人工关节假体置换术进行治疗。髋臼杯假体均植入真臼位置,7例13髋采用自体股骨头于髋臼外上方作结构性植骨,均作了粗隆下缩短截骨术,平均截骨长度为39.4 mm(35~50 mm)。结果平均随访30.8个月(6~62个月)。髋关节Harris评分明显改善(t=24.862,P0.01),从术前的平均(38.2±6.4)分(28~48分)到术后平均(82.1±8.6)分(62~94分)。术后肢体均得到不同程度的延长(t=12.099,P0.01),平均(33.5±12.7)mm(11~65 mm)。术前所有患者均有明显跛行,术后4例有轻度跛行,2例仍需扶双拐行走。19髋股骨截骨处愈合良好,2髋截骨处延迟愈合。在最后一次回访时显示髋臼假体和股骨柄假体位置均良好,无松动、下沉、断钉、骨溶解及异位骨化出现。髋关节中心平均下移了73.0 mm(46~105 mm)。结论利用S-ROM带股骨柄模块的生物固定型人工关节假体的高度适配性,加上在真臼位置加深髋臼,适当植骨,以及精确的粗隆下截骨,是治疗CroweⅣ型髋臼发育不良伴骨关节炎的良好选择。

Total hip arthroplasty with S-ROM prosthesis in the treatment for Crowe Ⅳ developmental hip dysplasia

Objective To summarize the results and experience of total hip arthroplasty with the subtrochanteric osteotomy and non-cement modular femoral stem total hip prosthesis for the Crowe Ⅳ developmental hip dysplasia with osteoarthritis. Methods Analysing 21 hips in 12 patients of Crowe Ⅳ developmental hip dysplasia with osteoarthritis resorted to us from February 2004 to April 2009 retrospectively, the details and effects of the treatment along with all the complications were recorded. All the affected 21 hips had a total hip arthroplasty with the subtrochanteric osteotomy and S-ROM non-cement modular femoral stem prosthesis. Acetabular cup prostheses were implanted in the anatomical acetabular socket. 13 hips of seven cases had a structural bone grafting with femoral head autograft at the lateral superior side of the acetabular socket, and a subtrochanteric shortening osteotomy was made in all cases. The average length of osteotomy was 39.4 mm （35 - 50 mm）. Results The mean follow-up time was 30. 8 months （6 -62 months ）. The Harris score was improved significantly from （38.2 ±6.4 ） points （28 - 48 points） preoperatively to （ 82. 1 ± 8.6 ） points （ 62 - 94 points ） postoperatively （ t = 24. 862, P 〈0. 01）. Limb length was improved significantly with an average of （33.5 ±12.7） mm （11 -65 mm） （ t = 12. 099, P 〈 0. 01 ）. Four patients had minor elaudieation and two patients were still crutches walking at the last follow-up. The femoral osteotomy healed well in 19 hips and two had a delayed healing. The acetabular and the femoral stem prostheses were in good position. No loosening, subsidence, screws breaking and osteolysis, nor heterotopic ossification occured. The hip center shifted distally to an average of 73.0 mm （46 to 105 mm） postoperatively. Conclusions It is a good choice for the Crowe Ⅳ developmental dysplasia with osteoarthritis to perform a total hip arthroplasty using the high adaptivity of the S-ROM modular femoral stem prosthesis, combined with the acetabular cup prosthesis implanted in the deepened anatomical acetabular socket which was reinforced with structural bone grafting when necessary and the precise subtrochanteric osteotomy.