【摘要】 目的 探讨全髋关节置换术治疗成人Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip, DDH）的方法并评价其疗效。方法　1997年10月至2009年1月，应用全髋关节置换术治疗Crowe Ⅳ型DDH患者15例20髋，其中5例双侧、10例单侧。18髋采用Secur-Fit 股骨假体，2髋采用Corail股骨假体。转子下斜行截骨6髋，髋臼底磨穿5髋，均行股骨头植骨。结果　15例中早期死亡1例（双髋），失访2例（2髋），余12例16髋获得平均44.2个月（5～92个月）随访。术后发生出血性休克1例，脂肪栓塞1例，术后脱位2例，股骨上端骨裂2例。转子下斜行截骨6髋中，1髋失随访，2髋分别于术后18和23个月随访时仍可见骨折线，下肢行走无异常，其余3髋骨愈合。髋臼底植骨5髋，除1髋失访外，其余均获得愈合。术后X线片显示髋臼假体均位于真臼内，完全骨性覆盖，无髋臼假体松动。术后双下肢长度差平均1.1 cm（0～2.2 cm）。末次随访Harris评分由术前平均（24.7±5.7）分（15～32分）提高至末次随访（85.6±5.6）分（80～94分），差异有统计学意义。结论　对Crowe Ⅳ型DDH患者行全髋关节置换术时，良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用Secur-Fit假体能提高全髋关节置换术的治疗效果。

    【关键词】 关节成形术，置换，髋；髋脱位，先天性; 骨关节炎，髋; 截骨术

    【证据等级】 治疗性研究Ⅳ级

 

   Total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip　WU Yue-song, WANG Zi-min, WANG Zhi-wei, et al, Department of Orthopaedics, Shanghai Changhai Hospital, Shanghai 200433, China

    【Abstract】 Objective To develop the techniques in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip (DDH) and assess the clinical results. Methods From October 1997 to Janurary 2009, 15 patients (20 hips) with Crowe type Ⅳ DDH underwent THA, including 5 patients with bilateral hip involved, 10 patients with unilateral. 18 hips were treated with Secur-Fit prosthesis while 2 hips were treated with Corail prosthesis. 6 hips underwent oblique subtrochanteric shortening osteotomy. 5 acetabulums were reaming through and were grafted with femoral head. Postoperative clinical and radiological results were evaluated. Results 2 patients lost of follow-up. 12 patients (16 hips) were followed up for the average 44.2 (5-92) months. There were 1 patient with bilateral THA died from hemorrhagic shock and MOF 1 week after operation, 1 patient with fat embolism survived, 2 cases with dislocation, 2 cases with femoral fracture. Among the 6 cases with osteotomy, 1 lost of follow up, 2 could walk freely with the visible fracture lines at 18 and 23 months postoperatively, 3 got union. Among the 5 cases with acetabular graft with femoral head, 1 lost of follow up, 4 were observed with union. The main Harris score was promoted from 24.7±5.7 preoperatively to 85.6±5.6 postoperatively(t=27.3, P=0.000). Conclusion For the complex DDH, this paper presents the trick to expose the true acetabulum, deepen acetabulum, femoral shortening, oblique osteotomy, using of the Secur-Fit prosthesis. THA associated with these techniques can effectively improve the outcomes of Crowe type Ⅳ DDH.

    【Key words】 Arthroplasty, replacement, hip; Hip dislocation, congenital; Osteoarthritis, hip; Osteotomy.