高位全髋关节置换治疗CroweⅡ和Ⅲ型成人髋臼发育不良High acetabular placement in total hip arthroplasty for Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip in adult
万安营;唐淼;刘忠堂;亓文静;
摘要(Abstract):
[目的]观察全髋关节置换术(total hip arthroplasty, THA)中髋臼高位放置治疗CroweⅡ型、Ⅲ型髋关节发育不良(developmental dysplasia of the hips, DDH)的临床疗效。[方法]回顾性分析2014年2月~2016年10月本院收治的行THA治疗的21例(28髋) CroweⅡ型和Ⅲ型DDH患者(高位放置组),以同期19例(26髋)接受THA治疗的CroweⅠ型DDH患者为对照(解剖位放置组)。采用Trendelenburg征和Harris髋关节评分评价临床效果,拍摄双髋关节正侧位X线片,测量髋关节旋转中心距泪滴的垂直距离和水平距离、下肢长度差异。[结果]高位放置组手术时间和术中出血量均低于解剖位放置组,差异有统计学意义(P<0.05)。术后2年时,CroweⅠ型、CroweⅡ型和CroweⅢ型DDH患者Harris评分的差异无统计学意义(P>0.05)。术后所有患者步态良好,无跛行发生,Trendelanburg征均为阴性。所有患者X线片均未见放射性透亮线和假体下沉,高位放置组和解剖位放置组双下肢长度差值比较差异无统计学意义。CroweⅡ型和Ⅲ型患者髋关节旋转中心距泪滴的垂直距离均高于CroweⅠ型患者(P<0.05),而组间水平距离的比较差异无统计学意义(P>0.05)。[结论] THA术中髋臼高位放置治疗CroweⅡ型、Ⅲ型DDH的效果较好,未来需要扩大样本量,并进行长期随访,以证实本研究结论。
关键词(KeyWords): 髋关节发育不良;成人;全髋关节置换术;髋臼高位放置
基金项目(Foundation): 国家自然科学基金项目(编号:81371936)
作者(Author): 万安营;唐淼;刘忠堂;亓文静;
Email:
DOI:
参考文献(References):
- [1] Schaeffer EK, Study GI, Mulpuri K. Developmental dysplasia of the hip:addressing evidence gaps with a multicentre prospective international study[J]. Med J Aust, 2018, 208(8):359-364.
- [2] Cooper AP, Doddabasappa SN, Mulpuri K. Evidence-based management of developmental dysplasia of the hip[J].Orthop Clin North Am, 2017, 45(3):341-354.
- [3] Greber EM, Pelt CE, Gililland JM, et al. Challenges in total hip arthroplasty in the setting of developmental dysplasia of the hip[J].J Arthroplasty, 2017, 32(9):38-44.
- [4] Alessa RS, Aljahdali FH, Alkhilaiwi RM, et al. Diagnosis and treatment of developmental dysplasia of the hip:a current practice of paediatric orthopaedic surgeons[J].J Orthop Surg, 2017, 25(2):1-8.
- [5]朴尚,杜银桥,周勇刚.髋臼高位放置技术在人工髋关节置换中的应用研究与进展[J].中国组织工程研究, 2017, 21(11):1776-1782.
- [6] Rasi AM, Kazemian G, Khak M, et al. Shortening subtrochanteric osteotomy and cup placement at true acetabulum in total hip arthroplasty of Crowe III-IV developmental dysplasia:results of midterm follow-up[J].Eur J of Orthop Surg Traumatol, 2017, 28(5):923-930.
- [7] Chen M, Luo ZL, Wu KR, et al. Cementless total hip arthroplasty with a high hip center for hartofilakidis type b developmental dysplasia of the hip:results of midterm follow-up[J].J Arthroplasty,2016, 31(5):1027-1034.
- [8] Xu J, Xu C, Mao Y, et al. Posterosuperior placement of a standardsized cup at the true acetabulum in acetabular reconstruction of developmental dysplasia of the hip with high dislocation[J].J Arthroplasty, 2016, 31(6):1233-1239.
- [9] Philippot R, Camilleri JP, Boyer B, et al. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty:analysis of 384 cases at a mean follow-up of15 years[J].Int Orthop, 2009, 33(4):927-932.
- [10] Tetsunaga T, Fujiwara K, Endo H, et al. Calcar femorale in patients with osteoarthritis of the hip secondary to developmental dysplasia[J].Clin Orthop Surg, 2017, 9(4):413-419.
- [11]吴天昊,郭江,张才东,等.成人Crowe III型DDH全髋关节置换术的髋臼重建方法探究[J].中国伤残医学, 2017, 25(12):1-4.
- [12]朱贤平,滕晓,泮宸帅,等.旋转中心内移结合上移重建髋臼技术治疗CroweⅡ、Ⅲ型成人发育性髋关节发育不良的疗效分析[J/CD].中华危重症医学杂志(电子版), 2017, 10(1):34-37.
- [13] Makita H, Kerboull M, Inaba Y, et al. Revision total hip arthroplasty using the kerboull acetabular reinforcement device and structural allograft for severe defects of the acetabulum[J].J Arthroplasty,2017, 32(11):3502-3509.
- [14]王琦,张先龙,蒋垚,等.髋关节表面置换术治疗CroweⅠ、Ⅱ型髋关节发育不良[J].中华解剖与临床杂志, 2014, 19(1):19-23.
- [15] Biani G, Aljinovi A, Delimar D. Failure of bulk bone grafts after total hip arthroplasty for hip dysplasia[J]. Arch Orthop Trauma Surg, 2014, 134(8):1167-1173.
- [16] Antoniades J, Pellegrini VJ. Cross-sectional anatomy of the ilium:implications for acetabular component placement in total hip arthroplasty[J]. Clin Orthop, 2012, 470(12):3537-3541.
- [17]冉学军,蒲川成,胡兆洋,等. CroweⅢ、Ⅳ型成人髋臼发育不良THA术中髋臼重建体会[J].中国骨与关节损伤杂志, 2018, 33(2):159-160.
- [18] Montalti M, Castagnini F, Giardina F, et al. Cementless total hip arthroplasty in croweⅢandⅣdysplasia:high hip center and modular necks[J].J Arthroplasty, 2018, 33(6):1813-1819.
- [19] Yang TC, Chen CF, Tsai SW, et al. Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III-IV irreducible development dysplasia of the hip[J].J Chin Med Assoc, 2017, 80(12):803-807.
- [20] Bicanic G, Delimar D, Delimar M, et al. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia[J].Int Orthop, 2009, 33(2):397-402.
- [21]王振江,强晓军,刘涛,等. CroweⅢ型发育性髋关节发育不良全髋关节置换术中臼杯高位和解剖位安放的临床疗效对比分析[J].中国骨伤, 2018, 31(10):922-926.