股骨转子下叠加截骨的人工全髋关节置换术治疗CroweⅣ型成人发育性髋关节发育不良_《中国修复重建外科杂志》

作者：

李彪 , 郭双红 , 龚跃昆 , 粟钦 , 杨毅 , 毕鑫

昆明医科大学第一附属医院骨科（昆明，650031）;

关键词：

发育性髋关节发育不良股骨转子下截骨人工全髋关节置换术成人

DOI：

10.7507/1002-1892.20130143

视频：

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目的探讨股骨转子下叠加截骨的人工全髋关节置换术治疗CroweⅣ型成人发育性髋关节发育不良（developmental dysplasia of the hip，DDH）的疗效。方法2004年1月－2010年12月，收治37例44髋CroweⅣ型成人DDH。男15例18髋，女22例26髋；年龄24～46岁，平均42岁。单髋30例，双髋7例。术前X线片示股骨头完全脱位，髋臼及股骨近端发育不良。患肢短缩明显，双下肢不等长（5.5 ± 1.1）cm。Harris评分为（32.1 ± 5.2）分。采用股骨转子下叠加短缩截骨后非骨水泥型假体置换。结果手术时间3～6 h，平均4.3 h；术中出血量600～1 000 mL，平均760 mL。患者切口均Ⅰ期愈合。37例均获随访，随访时间1～8年，平均6.7年。术后患者关节疼痛均消失；6例遗留轻度跛行，3例合并股神经麻痹，无坐骨神经牵拉伤表现。X线片示臼杯均位于真臼区；截骨端均骨性愈合，愈合时间3～6 个月，平均3.7个月。术后1 d测量双下肢不等长（1.5 ± 1.0）cm，与术前比较差异有统计学意义（t=16.45，P=0.00）。术后3个月Harris评分改善至（94.3 ± 3.8）分，与术前比较差异有统计学意义（t=59.15，P=0.00）。随访期间均无假体翻修。结论股骨转子下叠加截骨的人工全髋关节置换术因短缩股骨，可避免软组织挛缩所致的复位困难以及肢体延长过多所致的坐骨神经及股神经损伤，是治疗CroweⅣ型成人DDH的有效术式之一。

引用本文： 李彪,郭双红,龚跃昆,粟钦,杨毅,毕鑫. 股骨转子下叠加截骨的人工全髋关节置换术治疗CroweⅣ型成人发育性髋关节发育不良. 中国修复重建外科杂志, 2013, 27(6): 645-648. doi: 10.7507/1002-1892.20130143 复制

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, 龚跃昆, 张磊, 等. 生物型全髋关节置换术治疗成人髋关节发育不良. 中国修复重建外科杂志, 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, 黄明, 高明杰, 等. 后外侧入路高脱位髋关节假体重建软组织处理. 解剖与临床, 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.	吴岳嵩, 汪滋民, 王志伟, 等. Crowe Ⅳ型髋关节发育不良的全髋关节置换术. 中华骨科杂志, 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.	刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6): 643-645.
18.	高伟强, 陈经勇, 成俊, 等. 自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效. 中国组织工程研究与临床康复, 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, 龚跃昆, 张磊, 等. 生物型全髋关节置换术治疗成人髋关节发育不良. 中国修复重建外科杂志, 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, 黄明, 高明杰, 等. 后外侧入路高脱位髋关节假体重建软组织处理. 解剖与临床, 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. 吴岳嵩, 汪滋民, 王志伟, 等. Crowe Ⅳ型髋关节发育不良的全髋关节置换术. 中华骨科杂志, 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. 刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6): 643-645.
18. 高伟强, 陈经勇, 成俊, 等. 自体股骨头植骨生物型人工全髋关节置换治疗髋关节发育不良的疗效. 中国组织工程研究与临床康复, 2011, 15(26): 4785-4787.

《中国修复重建外科杂志》

股骨转子下叠加截骨的人工全髋关节置换术治疗CroweⅣ型成人发育性髋关节发育不良

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《中国修复重建外科杂志》

股骨转子下叠加截骨的人工全髋关节置换术治疗CroweⅣ型成人发育性髋关节发育不良

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