股骨轉子下疊加截骨的人工全髖關節置換術治療CroweⅣ型成人發育性髖關節發育不良_《中國修復重建外科雜志》

作者：

李彪 , 郭雙紅 , 龔躍昆 , 粟欽 , 楊毅 , 畢鑫

昆明醫科大學第一附屬醫院骨科（昆明，650031）;

關鍵詞：

發育性髖關節發育不良股骨轉子下截骨人工全髖關節置換術成人

DOI：

10.7507/1002-1892.20130143

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目的探討股骨轉子下疊加截骨的人工全髖關節置換術治療CroweⅣ型成人發育性髖關節發育不良（developmental dysplasia of the hip，DDH）的療效。方法2004年1月－2010年12月，收治37例44髖CroweⅣ型成人DDH。男15例18髖，女22例26髖；年齡24～46歲，平均42歲。單髖30例，雙髖7例。術前X線片示股骨頭完全脫位，髖臼及股骨近端發育不良。患肢短縮明顯，雙下肢不等長（5.5 ± 1.1）cm。Harris評分為（32.1 ± 5.2）分。采用股骨轉子下疊加短縮截骨后非骨水泥型假體置換。結果手術時間3～6 h，平均4.3 h；術中出血量600～1 000 mL，平均760 mL。患者切口均Ⅰ期愈合。37例均獲隨訪，隨訪時間1～8年，平均6.7年。術后患者關節疼痛均消失；6例遺留輕度跛行，3例合并股神經麻痹，無坐骨神經牽拉傷表現。X線片示臼杯均位于真臼區；截骨端均骨性愈合，愈合時間3～6 個月，平均3.7個月。術后1 d測量雙下肢不等長（1.5 ± 1.0）cm，與術前比較差異有統計學意義（t=16.45，P=0.00）。術后3個月Harris評分改善至（94.3 ± 3.8）分，與術前比較差異有統計學意義（t=59.15，P=0.00）。隨訪期間均無假體翻修。結論股骨轉子下疊加截骨的人工全髖關節置換術因短縮股骨，可避免軟組織攣縮所致的復位困難以及肢體延長過多所致的坐骨神經及股神經損傷，是治療CroweⅣ型成人DDH的有效術式之一。

引用本文： 李彪,郭雙紅,龔躍昆,粟欽,楊毅,畢鑫. 股骨轉子下疊加截骨的人工全髖關節置換術治療CroweⅣ型成人發育性髖關節發育不良. 中國修復重建外科雜志, 2013, 27(6): 645-648. doi: 10.7507/1002-1892.20130143 復制

1.	Hartofilakidis G, Georgiades G, Babis GC, et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease: results after a minimum ten-year follow-up. J Bone Joint Surg (Br), 2008, 90(6): 724-730.
2.	李彪, 龔躍昆, 張磊, 等. 生物型全髖關節置換術治療成人髖關節發育不良. 中國修復重建外科雜志, 2008, 22(6): 646-648.
3.	Starker M, Bischof F, Lindenfeld T. Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia. Z Orthop Unfall, 2011, 149(5): 518-525.
4.	王皓宇, 黃明, 高明杰, 等. 后外側入路高脫位髖關節假體重建軟組織處理. 解剖與臨床, 2011, 16(5): 412-414.
5.	Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2): 339-345.
6.	Nakamura Y, Mitsui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
7.	Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): S1033-1036.
8.	Bruce WJ, Rizkallah SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
9.	Faldini C, Nanni M, Leonetti D, et al. Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int, 2011, 21(4): 415-420.
10.	Fousek J, Indráková P. Total hip arthroplasty in post-dysplastic hip arthritis. Can type and position of the acetabular component influence longevity of the prosthesis? Acta Chir Orthop Traumatol Cech, 2007, 74(1): 47-54.
11.	Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3): 207-211.
12.	Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
13.	Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
14.	吳岳嵩, 汪滋民, 王志偉, 等. Crowe Ⅳ型髖關節發育不良的全髖關節置換術. 中華骨科雜志, 2010, 30(2): 129-136.
15.	Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
16.	de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
17.	劉瑞宇, 王坤正, 王春生, 等. 三維表面遮蓋法結合多平面重建在成人髖關節發育不良全髖關節置換術前髖臼評估中的應用. 中國修復重建外科雜志, 2008, 22(6): 643-645.
18.	高偉強, 陳經勇, 成俊, 等. 自體股骨頭植骨生物型人工全髖關節置換治療髖關節發育不良的療效. 中國組織工程研究與臨床康復, 2011, 15(26): 4785-4787.

1. Hartofilakidis G, Georgiades G, Babis GC, et al. Evaluation of two surgical techniques for acetabular reconstruction in total hip replacement for congenital hip disease: results after a minimum ten-year follow-up. J Bone Joint Surg (Br), 2008, 90(6): 724-730.
2. 李彪, 龔躍昆, 張磊, 等. 生物型全髖關節置換術治療成人髖關節發育不良. 中國修復重建外科雜志, 2008, 22(6): 646-648.
3. Starker M, Bischof F, Lindenfeld T. Total hip arthroplasty with shortening subtrochanteric osteotomy and custom-made prosthesis in Crowe type IV developmental dysplasia. Z Orthop Unfall, 2011, 149(5): 518-525.
4. 王皓宇, 黃明, 高明杰, 等. 后外側入路高脫位髖關節假體重建軟組織處理. 解剖與臨床, 2011, 16(5): 412-414.
5. Lai KA, Shen WJ, Huang LW, et al. Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation. J Bone Joint Surg (Am), 2005, 87(2): 339-345.
6. Nakamura Y, Mitsui H, Kikuchi A, et al. Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty, 2011, 26(1): 77-81.
7. Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): S1033-1036.
8. Bruce WJ, Rizkallah SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
9. Faldini C, Nanni M, Leonetti D, et al. Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int, 2011, 21(4): 415-420.
10. Fousek J, Indráková P. Total hip arthroplasty in post-dysplastic hip arthritis. Can type and position of the acetabular component influence longevity of the prosthesis? Acta Chir Orthop Traumatol Cech, 2007, 74(1): 47-54.
11. Sun JY, Wei L. Subtrochanteric shortening with overlapping femoral resection in total hip arthroplasty for Crowe type IV adult dislocation of the hip. Orthop Surg, 2009, 1(3): 207-211.
12. Dallari D, Pignatti G, Stagni C, et al. Total hip arthroplasty with shortening osteotomy in congenital major hip dislocation sequelae. Orthopedics, 2011, 34(8): e328-333.
13. Kim M, Kadowaki T. High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res, 2010, 468(6): 1611-1620.
14. 吳岳嵩, 汪滋民, 王志偉, 等. Crowe Ⅳ型髖關節發育不良的全髖關節置換術. 中華骨科雜志, 2010, 30(2): 129-136.
15. Hendrich C, Mehling I, Sauer U, et al. Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg (Am), 2006, 88(2): 387-394.
16. de Jong PT, Haverkamp D, van der Vis HM, et al. Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg (Br), 2006, 88(2): 173-178.
17. 劉瑞宇, 王坤正, 王春生, 等. 三維表面遮蓋法結合多平面重建在成人髖關節發育不良全髖關節置換術前髖臼評估中的應用. 中國修復重建外科雜志, 2008, 22(6): 643-645.
18. 高偉強, 陳經勇, 成俊, 等. 自體股骨頭植骨生物型人工全髖關節置換治療髖關節發育不良的療效. 中國組織工程研究與臨床康復, 2011, 15(26): 4785-4787.

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股骨轉子下疊加截骨的人工全髖關節置換術治療CroweⅣ型成人發育性髖關節發育不良

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股骨轉子下疊加截骨的人工全髖關節置換術治療CroweⅣ型成人發育性髖關節發育不良

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