目的 探討人工全髖關(guān)節(jié)置換術(shù)（total hip arthroplasty，THA）治療成人Crowe Ⅳ型先天性髖關(guān)節(jié)發(fā)育不良伴脫位的髖臼假體選擇及療效。 方法2008年6月－2012年5月，收治8例8髖Crowe Ⅳ型先天性髖關(guān)節(jié)發(fā)育不良伴脫位女性患者；年齡20～35歲，平均25歲。左髖5例，右髖3例?；俭yHarris評(píng)分為（53.9 ± 6.6）分?；贾^健側(cè)短縮4～6 cm，平均4.8 cm。X線片示患髖均完全高位脫位。術(shù)中采用42～44 mm小號(hào)髖臼假體、S-ROM股骨假體并轉(zhuǎn)子下截骨行THA。 結(jié)果患者切口均Ⅰ期愈合，無髖關(guān)節(jié)脫位、坐骨神經(jīng)損傷發(fā)生。術(shù)后2 d 1例發(fā)生股神經(jīng)損傷，術(shù)后7 d 2例出現(xiàn)無癥狀下肢肌間靜脈血栓形成，均經(jīng)對(duì)癥處理后治愈。8例均獲隨訪，隨訪時(shí)間1～5年，平均3年?；颊咝g(shù)前跛行步態(tài)均明顯改善，均恢復(fù)日常工作。術(shù)后6個(gè)月測(cè)量患肢長(zhǎng)度與健側(cè)相差—1.0～0.6 cm，平均0.4 cm。髖關(guān)節(jié)Harris評(píng)分達(dá)（87.6 ± 0.3）分，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（t=1.77，P=0.00）。X線片復(fù)查示，股骨截骨處均在術(shù)后3～6 個(gè)月愈合；髖臼假體-骨界面穩(wěn)固，無松動(dòng)。隨訪期間無假體翻修。 結(jié)論使用小號(hào)髖臼假體并轉(zhuǎn)子下截骨行THA是治療成人Crowe Ⅳ型先天性髖關(guān)節(jié)發(fā)育不良伴脫位的有效方法之一，近期療效較滿意，但假體遠(yuǎn)期生存率仍需進(jìn)一步觀察。
引用本文： 李文波,張文明,白國(guó)昌,黃子達(dá),沈榮凱. 人工全髖關(guān)節(jié)置換術(shù)治療成人Crowe Ⅳ型先天性髖關(guān)節(jié)發(fā)育不良伴脫位. 中國(guó)修復(fù)重建外科雜志, 2013, 27(10): 1153-1156. doi: 復(fù)制
| 1. | Gee MJ, Ajuied A, Shah Z, et al. Systematic review of total hip arthroplasty in patients under 30 years old. Hip Int, 2013. [Epub ahead of print]. |
| 2. | Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23. |
| 3. | Cameron HU, Botsford DJ, Park YS. Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty, 1996, 11(5): 582-587. |
| 4. | Noble PC, Kamaric E, Sugano N, et al. Three-dimentional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, (417): 27-40. |
| 5. | Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): s1033-1036. |
| 6. | Bruce WJ, Rizkallall 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. |
| 7. | Dapuzzo MR, Sierra RJ. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am, 2012, 43(3): 369-375. |
| 8. | Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444. |
| 9. | Rozkydal Z, Smid Z, Kristek J. Structural bone grafting in THR with cup for dysplastic hip. Acta Chir Orthop Traumatol Cech, 2000, 67(5): 298-306. |
| 10. | Somferd MP, Bolder SB, Gardeniers JW, et al. Favorable survival of acetabular reconstruction with bone impaction grafting in dysplastic hips. Clin Orthop Relat Res, 2008, 466(2): 359-365. |
| 11. | Linde F, Jermen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res, 1988, (227): 164-171. |
| 12. | 康鵬德, 楊靜, 沈彬, 等. CroweⅣ型髖關(guān)節(jié)發(fā)育不良全髖關(guān)節(jié)置換術(shù)前計(jì)算機(jī)輔助設(shè)計(jì). 中華骨科雜志, 2012, 32(5): 442-446. |
| 13. | Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801. |
| 14. | Bartz RL, Nobel PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307. |
| 15. | 趙德偉, 劉宇鵬, 崔旭. 大齡中、高位先天性髖脫位全髖置換術(shù)方法探討. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2006, 21(5): 350-352. |
| 16. | Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141. |
| 17. | Willis-Owen CA, Nishiwaki T, Spriggins AJ. Sciatic palsy after total hip arthroplasty associated with vascular graft occlusion. Hip Int, 2011, 21(1): 118-121. |
| 18. | Neumann D, Thaler C, Dorn U. Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip. Int Orthop, 2012, 36(3): 499-503. |
- 1. Gee MJ, Ajuied A, Shah Z, et al. Systematic review of total hip arthroplasty in patients under 30 years old. Hip Int, 2013. [Epub ahead of print].
- 2. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
- 3. Cameron HU, Botsford DJ, Park YS. Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty, 1996, 11(5): 582-587.
- 4. Noble PC, Kamaric E, Sugano N, et al. Three-dimentional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, (417): 27-40.
- 5. Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): s1033-1036.
- 6. Bruce WJ, Rizkallall 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.
- 7. Dapuzzo MR, Sierra RJ. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am, 2012, 43(3): 369-375.
- 8. Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444.
- 9. Rozkydal Z, Smid Z, Kristek J. Structural bone grafting in THR with cup for dysplastic hip. Acta Chir Orthop Traumatol Cech, 2000, 67(5): 298-306.
- 10. Somferd MP, Bolder SB, Gardeniers JW, et al. Favorable survival of acetabular reconstruction with bone impaction grafting in dysplastic hips. Clin Orthop Relat Res, 2008, 466(2): 359-365.
- 11. Linde F, Jermen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res, 1988, (227): 164-171.
- 12. 康鵬德, 楊靜, 沈彬, 等. CroweⅣ型髖關(guān)節(jié)發(fā)育不良全髖關(guān)節(jié)置換術(shù)前計(jì)算機(jī)輔助設(shè)計(jì). 中華骨科雜志, 2012, 32(5): 442-446.
- 13. Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801.
- 14. Bartz RL, Nobel PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307.
- 15. 趙德偉, 劉宇鵬, 崔旭. 大齡中、高位先天性髖脫位全髖置換術(shù)方法探討. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2006, 21(5): 350-352.
- 16. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141.
- 17. Willis-Owen CA, Nishiwaki T, Spriggins AJ. Sciatic palsy after total hip arthroplasty associated with vascular graft occlusion. Hip Int, 2011, 21(1): 118-121.
- 18. Neumann D, Thaler C, Dorn U. Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip. Int Orthop, 2012, 36(3): 499-503.