摘要
[目的]探讨THA解剖重建髋臼旋转中心治疗成人发育性髋关节脱位的临床疗效。[方法]对2010年2月~2018年2月在本院行初次全髋关节置换的102例(118髋) DDH患者进行回顾性分析,其中男37例,女65例;年龄32~71岁,平均(66.35±4.65)岁。依据Crowe分型Ⅰ型60例(65髋),Ⅱ型28例(34髋),Ⅲ型9例(12髋),Ⅳ型5例(7髋)。记录比较各Crowe类型患者围手术期情况、随访和影像资料。[结果]在手术时间、切口大小、术中失血方面随Crowe分型等级增加而增加,Crowe Ⅰ、Ⅱ型组间比较差异无统计学意义(P>0.05),CroweⅢ、Ⅳ型组间比较差异无统计学意义(P>0.05),但Crowe Ⅰ、Ⅱ型与CroweⅢ、Ⅳ型组间比较差异有统计学意义(P<0.05)。所有患者切口均一期愈合,无感染。CroweⅡ型组术后出现脱位1例,在全麻下一期行手法复位,余患者未出现脱位等早期并发症。118髋随访2~8年,平均(5.94±2.06)年,随访期间,所有患者未再发生髋关节脱位、骨折等并发症。与术前相比,末次随访各Crowe分型组的VAS评分均显著减少,双侧下肢长度差值均显著减少,Harris评分均显著增加(P<0.05);术前和末次随访时, Harris评分依各Crowe分型等级增加而减少,总体差异均有统计学意义(P<0.05)。至末次随访时,所有患者均无明显疼痛、Trendelenburg征均为阴性。无假体松动、断裂。[结论]成人DDH行初次全髋关节置换在解剖位重建髋关节旋转中心可获得满意临床疗效。
[Objective] To investigate the clinical outcomes of anatomical reconstruction of the rotation center in total hip arthroplasty(THA) for developmental dysplasia of hip(DDH) in adult.[Methods] A retrospective study was conducted on 102 patients(118 hips) who underwent initial THA for DDH in our hospital from February 2010 to February 2018, including 37 males and 65 females with an average age of(66.35±4.65) years ranged from 32 to 71 years. In term of Crowe classification,there were 60 cases(65 hips) in type Ⅰ, 28 cases(34 hips) in type Ⅱ, 9 cases(12 hips) in type Ⅲ and 5 cases(7 hips) in type Ⅳ.The perioperative and follow-up data, as well as radiographic parameters were recorded and compared.[Results] The operation time, incision length and intraoperative blood loss increased as upgrading of Crowe classification, with statistically significant differences between the Crowe type Ⅰ/Ⅱ groups and Crowe type Ⅲ/Ⅳ groups(P<0.05), despite of no statistically significant differences between Crowe type Ⅰ and type Ⅱ group, or Crowe type Ⅲ and type Ⅳ groups(P>0.05). All patients had incision primary healing without infection. Except one patients in the Crowe type Ⅱ group who got dislocation that was treated by close reduction, all the patients had no serious complications in the early stage after operation. The followed-up period lasted for 2~8 years with an average of(5.94±2.06) years. The VAS score and discrepancy of bilateral lower extremities significantly decreased, while the Harris score significantly increased at the latest follow up compared with those before operation(P<0.05).The Harris score significantly decreased as upgrading of Crowe classification before operation and at the latest follow up(P<0.05). All the patients proved negative Trendelenburg sign, without obvious pain, loosening or fracture of the prosthesis in anyone of them to the latest follow up.[Conclusion] This anatomical reconstruction of the rotation center in THA for DDH in adults does achieve satisfactory clinical results.
作者
卢涛
孟乘飞
丁然
陈祖芳
蔡贤华
LU Tao;MENG Cheng-fei;DING Ran;CHEN Zu-fang;CAI Xian-hua(Department of Orthopedics,General Hospital of Central Theater Command,Wuhan 430070,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第11期971-975,共5页
Orthopedic Journal of China
