髋臼发育不良全髋关节置换术中髋臼的重建Reconstruction of the acetabulum in total hip arthroplasty in patient with developmental dysplasia of the hip
赵秀祥;卜延民;郑得志;于建华;
摘要(Abstract):
[目的]总结先天性髋臼发育不良继发骨性关节炎患者全髋关节置换术中髋臼重建的经验。[方法]2001年2月~2006年2月对45例成人髋臼发育不良继发骨性关节炎患者行全髋关节置换术,女40例,男5例,平均年龄52岁(40~63岁)。根据术前髋关节正位X线片分型,CroweⅠ型25例,CroweⅡ型10例,CroweⅢ型5例,CroweⅣ型5例。臼杯均在真臼位置生物压配固定。髋臼常规重建16例,加深髋臼至卵圆窝以内压配固定16例,,股骨头植骨8例,髋臼内壁截骨5例。于术后3、6、12个月,以后每年随访一次。摄X线片观察臼杯松动、植骨愈合情况。检查患者Trendelenburg征的变化,对髋关节功能进行Harris评分。[结果]完整随访41例,平均随访6年(3~8年)。旋转中心上移从术前(2.3±0.8)cm下降为术后(0.8±0.4)cm,P<0.05。Harris评分从术前(64±7.8)分提高到术后(93±6.2)分,P<0.05。Trendelenburg征阳性患者,从术前38例下降到术后5例。有5例X线表现臼杯松动,但无临床症状。2例植骨块明显吸收。1例因内衬破裂行翻修术。3例术后脱位,闭合复位后未再脱位。[结论]根据髋臼缺损的程度不同采用不同的重建方法,可获得臼杯的充分包容,近期疗效令人满意。
关键词(KeyWords): 关节成形术;髋;置换;髋脱位;先天性;随访研究
基金项目(Foundation):
作者(Author): 赵秀祥;卜延民;郑得志;于建华;
Email:
DOI:
参考文献(References):
- [1]Pagnano MW,Hanssen AD,Lewallen DG,et al.The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty.Long-term results in patients who have CroweⅡcongenital dysplasia of the hip[J].J Bone Joint Surgery Am,1996,78:1004-1014.
- [2]Onodera S,Majima T,Ito H,et al.Cementless total hip arthroplasty u-sing the modular S-ROM prosthesis combined with corrective proxi-mal femoral osteotomy[J].J Arthroplasty,2006,21:664-669.
- [3]常敏,周汝寿,郭英,等.全髋关节置换治疗成人髋臼发育不良并骨性关节炎疗效观察[J].中国矫形外科杂志,2008,23:1825-1827.
- [4]Dewal H,Chen F,Su E,et al.Use of structural bone graft with ce-mentless acetabular cups in total hip arthroplasty[J].J Arthroplasty,2003,18:23-27.
- [5]Park MS,Kim KH,Jeong WC.Transverse subtrochanteric shortening ooteotomy in primary total hip arthroplasty for patients with severe hip development dysplasia[J].J Arthroplasty,2007,7:1031-1036.
- [6]Papachristou G.Total hip arthroplasty for developmental hip dysplasia[J].Int Orthop,2006,30:21-25.
- [7]Siebenrock KA,Tannast N.Acetabular reconstruction using a roof re-inforcement ring with hook for total hip arthroplasty in developmental dysplasia of the hip-osteoarthristis[J].J Arthroplasty,2005,4:492-498.
- [8]Abeyta PN,Namba RS.Reconstruction of major segmental acetabular defects with an oblong-shaped cementless prosthesis[J].J Arthro-plasty,2008,2:247-253.