[node:field-long-title]

第一作者：赵秀祥

2010-11-30 点击量：2037 　　我要说

赵秀祥 于建华 卜延民 郑得志

    【摘要】 目的 探讨股骨转子下横行短缩截骨在Crowe Ⅳ型髋关节发育不良全髋关节置换中的作用。方法 2001年2月至2007年2月对12例Crowe Ⅳ型髋关节发育不良患者行股骨转子下横行短缩截骨的全髋关节置换。男3例，女9例；年龄45~65岁，平均54岁。左髋5例，右髋6例，双髋1例。术前患肢短缩1.8~5.0 cm，平均3.5 cm。4例中度跛行，8例重度跛行。于术后3、6、12个月，以后每年随访一次。摄X线片观察截骨愈合、假体下沉及松动情况。观察患者跛行情况，髋关节功能评价采用Harris评分。结果 全部患者随访2～7年，平均3.0年。截骨长度1.5~4.2 cm，平均2.2 cm。无坐骨神经损伤。截骨均愈合，愈合时间3~15个月，平均5.3个月。末次随访时3例轻度跛行，4例中度跛行，无重度跛行患者。髋关节Harris评分从术前平均36分（30~60分）提高到末次随访平均83分（75~95分）。2髋分别于术后5年和7年发生股骨假体下沉，下沉高度分别为3 mm和6 mm。无假体松动及术后感染。结论    对Crowe Ⅳ型髋关节发育不良患者实施全髋关节置换术时行转子下横行短缩截骨，为真臼的暴露、臼杯的准确安装、增加股骨假体柄直径、矫正股骨假体柄前倾角创造了条件，可避免神经损伤。

    【关键词】 髋脱位，先天性；关节成形术，置换，髋；截骨术
    【证据等级】 治疗性研究Ⅳ级
 
    Application of subtrochanteric shortening osteotomy in total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip ZHAO Xiu-xiang,YU Jian-hua,BU Yan-min,et al.Department of Joint Orthopaedics,Tianjin Hospital,Tianjin 300211,China
    【Abstract】 Objective To observe the effect of transverse subtrochanteric femoral shortening osteotomy in total hip arthroplasty (THA) for Crowe type Ⅳ developmental dysplasia of the hip(DDH).Methods From February 2001 to February 2007,12 patients with Crowe type Ⅳ DDH were performed primary THA combined with transverse subtrochanteric femoral shortening osteotomy.There were 3 males and 9 females,with the average age of 54 years（ranged,45-65 years）.Five hips were left,7 hips were right and both sides for 1 patient.The average leg length discrepancy were 3.5 cm (ranged,1.8-5.0 cm).There were 4 patients with moderate limp and 8 patients with servere limp.Clinical and radiographic data were retrospectively reviewed at the 3rd,6th,12th month after operation, and then it was done every year.The bone union, prosthesis subsidence,leg limp and the hip Harris score were evaluated.Results The average follow-up was 3.0 years(2-7 years),and the average length of shortening osteotomy was 2.2 cm (1.5-4.2 cm).No nerve injury and nonunion occurred.At ther final follow-up,there were 3 cases of mild limp,4 cases of moderate limp and no severe ones.The mean Harris score improved from 36 (30-60) before operation to 83 (75-95).The mean union time was 5.3 months after operation (3-24 months after operation).The prosthesis subsidences were found in 1 case at the 5th year after operation and 1 case at the 7th year after operation,and with the subsiding height of 3 mm and 6 mm respectively. No loosening and infection were found in all patients. Conclusion Transverse subtrochanteric shortening osteotomy for Crowe type Ⅳ DDH is easy to performe. It can help to expose the true actabulum and fix the socket precisely, and also facilitate to improve the diameter of the prosthesis,correct the anterversion, and prevent nerve injury.
    【Key words】 Hip dislocation,congenital;Arthroplasty,replacement,hip;Osteotomy
分享到：