| CroweⅣ型髋臼发育不良并骨性关节炎的手术治疗 |
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投稿时间：2015-11-12
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| 作者 | Author | 单位 | Address | E-Mail |
| 尚大财 |
SHANG Da-cai |
青海省仁济医院骨科, 青海 西宁 810021 |
Department of Orthopaedics, Renji Hospital of Qinghai, Xining 810021, Qinghai, China |
shangdacai215@126.com |
| 钟生财 |
ZHONG Sheng-cai |
青海省仁济医院骨科, 青海 西宁 810021 |
Department of Orthopaedics, Renji Hospital of Qinghai, Xining 810021, Qinghai, China |
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| 张小兆 |
ZHANG Xiao-zhao |
青海省仁济医院骨科, 青海 西宁 810021 |
Department of Orthopaedics, Renji Hospital of Qinghai, Xining 810021, Qinghai, China |
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| 逯登鹏 |
LU Deng-peng |
青海省仁济医院骨科, 青海 西宁 810021 |
Department of Orthopaedics, Renji Hospital of Qinghai, Xining 810021, Qinghai, China |
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| 刘钦林 |
LIU Qin-lin |
青海省仁济医院骨科, 青海 西宁 810021 |
Department of Orthopaedics, Renji Hospital of Qinghai, Xining 810021, Qinghai, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第2期，第125-130页 |
| DOI：10.3969/j.issn.1003-0034.2016.02.007 |
| 基金项目: |
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中文摘要:
目的:探讨成人Crowe Ⅳ型髋臼发育不良并骨性关节炎行人工全髋关节置换术的方法及治疗效果.
方法:2006年5月至2013年12月对15例(17髋)成人CroweⅣ级的患者行人工全髋关节置换手术,女13例,男2例,平均年龄30.9岁(22~58岁),术前Harris评分34.0±6.5.术前未行患肢牵引,术中在广泛松解、延长软组织的基础上,行股骨粗隆下截骨,重建髋关节旋转中心及髋关节外展功能.
结果:术后所有患者获随访,平均随访时间33个月(6个月~5年),Harris评分85.0±7.3,较术前提高.患肢延长1.6~5.4 cm,平均(3.42±0.65) cm,大部分患者单侧肢体缩短畸形明显得到纠正,双下肢不等长控制在1. 5 cm之内.术后1例出现坐骨神经不完全损伤,经保守治疗3个月后基本恢复;1例出现坐骨神经完全损伤,经保守治疗6个月后部分恢复,患肢远端形成足下垂内翻畸形,经行肌腱转位移植术后得以好转.关节疼痛缓解,活动功能满意,随访期内未发生脱位、感染、假体松动、下沉等严重并发症.
结论:通过软组织松解延长、股骨粗隆下截骨、重建关节功能、选择合适的假体,并注重对神经血管的保护,成人Crowe Ⅳ型髋臼发育不良并骨性关节炎可以通过人工全髋关节置换术获得满意的治疗效果. |
| 【关键词】髋脱位,先天性 骨关节炎,髋 关节成形术,置换,髋 |
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| Surgical treatment for osteoarthritis secondary to Crowe type Ⅳ developmental dysplasia of hip in adults |
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ABSTRACT
Objective:To investigate the mothod and therapeutic efficacy of total hip anthroplasties(THA) for osteoarthritis secondary to Crowe type Ⅳ developmental dysplasia of hip in adults.
Methods:From May 2006 to December 2013,THA was performed on 15 adult patients (17 hips) with Growe type Ⅳ acetabular dysplasia,including 13 females and 2 males,with a mean age of 30.9 years old (22 to 58 years old) and an average preoperative Harris score of (34.0±6.5) points. Traction of the affected limb was not performed before surgery. After extensive release and lengthening of soft tissues,sub-trochanteric osteotomy of the femur was performed,hip joint center was rebuilt and the abduction function was restored.
Results:The patients were followed up with a mean period of 33 months (ranged from 6 months to 5 years). The postoperative Harris score was 85.0±7.3,higher than the preoperative score. The extended length of limb ranged from 1.6 to 5.4 cm,with a mean of(3.42±0.65) cm. The shortening and malformation of the affected limb were corrected in the most patients,with the difference in length of the two legs less than 1.5 cm. After surgery,1 patient experienced partial sciatic nerve injury,which was largely recovered after 3 months of conservative treatment. One patient experienced complete sciatic nerve injury,which was partially recovered after 6 months of conservative treatment;a foot-drop varus deformity was formed in the distal end of the affected limb,which was improved after tendon transposition and transplantation. Joint pain was relieved,and the joint function was restored significantly. Over the follow-up period,no severe complications such as dislocation,infection,prosthesis loosening,or subsiding occurred.
Conclusion:Satisfactory efficacy can be achieved for adult Growe type Ⅳ acetabular dysplasia associated with osteoarthritis by THA,with proper soft tissue release and lengthening,sub-trochanteric osteotomy of femur,joint functional restoration,appropriate choice of prosthesis,and careful protection of nerves and vessels. |
| KEY WORDS Hip dislocation,congenital Osteoarthritis,hip Arthroplasty,replacement,hip |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 尚大财,钟生财,张小兆,逯登鹏,刘钦林.CroweⅣ型髋臼发育不良并骨性关节炎的手术治疗[J].中国骨伤,2016,29(2):125~130 |
| 英文格式: | SHANG Da-cai,ZHONG Sheng-cai,ZHANG Xiao-zhao,LU Deng-peng,LIU Qin-lin.Surgical treatment for osteoarthritis secondary to Crowe type Ⅳ developmental dysplasia of hip in adults[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(2):125~130 |
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