| 两种全髋关节置换术治疗成人单侧Crowe Ⅳ型髋关节发育不良 |
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投稿时间：2019-01-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 梅晓亮 |
MEI Xiao-liang |
南京医科大学金陵临床医学院 东部战区总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, General Hospital of Eastern Theater Command, PLA, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 张震祥 |
ZHANG Zhen-xiang |
南京医科大学金陵临床医学院 东部战区总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, General Hospital of Eastern Theater Command, PLA, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 童健 |
TONG Jian |
南京医科大学金陵临床医学院 东部战区总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, General Hospital of Eastern Theater Command, PLA, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 朱伟 |
ZHU Wei |
南京医科大学金陵临床医学院 东部战区总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, General Hospital of Eastern Theater Command, PLA, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
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| 赵建宁 |
ZHAO Jian-ning |
南京医科大学金陵临床医学院 东部战区总医院骨科, 江苏 南京 210002 |
Department of Orthopaedics, General Hospital of Eastern Theater Command, PLA, Jinling Clinical College of Nanjing Medical University, Nanjing 210002, Jiangsu, China |
zhaojianning.0207@163.com |
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| 期刊信息：《中国骨伤》2019年，第32卷，第9期，第792-797页 |
| DOI：10.3969/j.issn.1003-0034.2019.09.003 |
| 基金项目:国家自然科学基金（编号：81572111） |
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| 中文摘要:目的：比较非截骨和转子下截骨两种人工全髋关节置换术（total hip arthroplasty，THA）治疗成人Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）的临床疗效。方法：应用THA治疗35例单侧CroweⅣ型DDH患者，其中15例术中采用非截骨，20例采用股骨转子下截骨。两组患者性别、年龄、身体质量指数、侧别差异均无统计学意义（P>0.05），记录并比较两组手术时间、出血量、住院时间、术前及术后双下肢长度差、髋关节Harris评分。结果：35例患者获得随访，时间12～48个月，随访期间无髋关节感染、假体松动发生。非截骨组术后1例出现坐骨神经牵拉损伤、1例股神经皮神经分支损伤，3个月后均自行恢复。转子下截骨组术后1例出现髋关节脱位，给予闭合复位后无再次脱位发生，3例股骨近端劈裂骨折，给予钢丝固定治疗。两组手术时间、出血量与住院时间比较，差异均有统计学意义（P<0.05）。末次随访时两组Harris评分均较术前提高（P<0.05），两组间比较差异无统计学意义（P>0.05）。两组患者术后双下肢长度差比较，差异有统计学意义（P<0.05）。结论：非截骨THA治疗单侧CroweⅣ型DDH手术效果满意，该方法相对于股骨转子下截骨更简单。对于髋部软组织条件良好、患肢短缩>4 cm的CroweⅣ型DDH患者，可考虑采用非截骨全髋关节置换术。 |
| 【关键词】髋脱位,先天性 关节成形术,置换,髋 截骨术 |
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| Two different kinds of total hip arthroplasty for unilateral Crowe Ⅳ developmental dysplasia of the hip in adults |
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ABSTRACT
Objective:To compare the clinical effects of total hip arthroplasty(THA) with non-osteotomy and subtrochanteric osteotomy in the treatment of Crowe type Ⅳ hip dysplasia (DDH) in adults.
Methods:Data of 35 Crowe type Ⅳ DDH patients who underwent THA were analyzed retrospectively,the patients were divided into two groups:15 cases of non-osteotomy and 20 cases of subtrochanteric osteotomy. There was no significant difference in age,gender,body mass index between two groups (P>0.05). The operative time,bleeding volume,hospitalization duration,Harris hip score and the limb length discrepancy (LLD) were evaluated.
Results:All of the patients were followed up for 12 to 48 months,no prosthesis loosening or infection occurred by the end of follow-up. In non-osteotomy group,1 case had occurred by sciatic nerve injury and 1 case developed cutaneous branch injury of the femoral nerve,both of which were spontaneously recovered completely without treatment after 3 months. One case of dislocation occurred in subtrochanteric osteotomy group,after closed reduction,dislocation did not recur; three cases had proximal femoral crack fractures and received steel plate fixation; no reoperation was needed. There was significant difference in operation duration,bleeding volume,and hospitalization days between two groups(P<0.05). The Harris score at last follow-up was significantly increased compared with preoperative score in two groups(P<0.05),but there was no significant difference between two groups(P>0.05). The postoperative discrepancy of bilateral lower limbs had significant difference(P<0.05).
Conclusion:THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral Crowe Ⅳ developmental dysplasia of hip. Comparing with subtrochanteric osteotomy,the procedure of no femoral shortening osteotomy is easier technically. For unilateral high dislocation DDH patients with limb lengthening ≤ 4 cm and good tissue conditions,THA without femoral osteotomy may be considered. |
| KEY WORDS Hip dislocation,congenital Arthroplasty,replacement,hip Osteotomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 梅晓亮,张震祥,童健,朱伟,赵建宁.两种全髋关节置换术治疗成人单侧Crowe Ⅳ型髋关节发育不良[J].中国骨伤,2019,32(9):792~797 |
| 英文格式: | MEI Xiao-liang,ZHANG Zhen-xiang,TONG Jian,ZHU Wei,ZHAO Jian-ning.Two different kinds of total hip arthroplasty for unilateral Crowe Ⅳ developmental dysplasia of the hip in adults[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(9):792~797 |
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