| Crowe Ⅳ型发育性髋关节脱位全髋关节置换术中股骨截骨与否的对比研究 |
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Received:June 11, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 孙博 |
SUN Bo |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
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| 李科伟 |
LI Ke-wei |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
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| 侯颖周 |
HOU Ying-zhou |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
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| 王金良 |
WANG Jin-liang |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
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| 魏瑄 |
WEI Xuan |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
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| 王少华 |
WANG Shao-hua |
郑州市骨科医院关节病科Ⅱ, 河南 郑州 450000 |
DepartmentⅡof Joint Disease, Zhengzhou Orthopaedics Hospital, Zhengzhou 450000, Henan, China |
wangshaohua1719@163.com |
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| 期刊信息：《中国骨伤》2024年37卷，第10期，第972-977页 |
| DOI：10.12200/j.issn.1003-0034.20231086 |
| 基金项目:2023年度河南省医学科技攻关计划项目(编号:LHGJ20230770) |
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目的: 对比研究Crowe Ⅳ型发育性髋关节脱位(developmental dysplasia of the hip,DDH)全髋关节置换术(total hip arthroplasty,THA)中是否行股骨截骨的临床疗效。
方法: 回顾分析2012年至2017年行THA的单侧Crowe Ⅳ型DDH患者46例。根据手术方式不同分为两组,截骨组24例,男3例,女21例,年龄34~57(47.3±9.0)岁;非截骨组22例,男2例,女20例,年龄40~61(51.6±8.3)岁。观察比较两组患者手术时间、术中出血量、术后引流量、并发症发生情况、髋关节活动度、Harris评分、双侧下肢长度差以及影像学资料,测量术前股骨头脱位高度及术后S-ROM假体植入深度。
结果: 所有患者获得随访,截骨组随访2~6(3.8±1.2)年,非截骨组随访1~5(3.2±0.9)年。截骨组手术时间(136.8±18.9) min、术中出血量(709.8±89.4) ml、术后引流量(308.8±98.2) ml均大于非截骨组(100.7±15.8) min、(516.5±103.3) ml、(245.3±79.3) ml(P＜0.05)。两组末次随访时Harris评分均较术前明显改善(P＜0.05),但组间比较差异无统计学意义(P＞0.05)。两组末次随访双侧下肢长度差均较术前改善(P＜0.05),末次随访时非截骨组(0.7±0.2) cm 小于截骨组(1.2±0.4) cm(P＜0.05)。截骨组与非截骨组在术前髋关节活动度[(89.5±19.7)° vs (102.5±16.8)°]、术前股骨头脱位高度[(4.56±0.61) cm vs (3.10±0.73) cm)、术后S-ROM近端假体植入深度[(0.93±0.36) cm vs (1.67±0.28) cm],两组比较差异均有统计学意义(P＜0.05)。截骨组11例仍有跛行,非截骨组仅4例轻度跛行(P＜0.05)。非截骨组术后有3例神经损伤(1例坐骨神经、2例股神经)及1例假体周围骨折,截骨组术后有2例脱位及2例假体周围骨折。
结论: THA治疗Crowe Ⅳ型DDH术中是否截骨均可取得满意的临床疗效,明显改善肢体长度差异,但截骨更复杂费时且肢体长度差异更大,跛行发生率更高。术前髋关节活动范围小、脱位程度高、延长超过4 cm,近端畸形重的患者倾向使用截骨技术。 |
| [关键词]:发育性髋关节脱位 全髋关节置换 股骨截骨 |
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| Comparative study of total hip arthroplasty with and without femoral osteotomy in Crowe Ⅳ developmental dysplasia of the hip |
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Abstract:
Objective To compare the clinical effects of total hip arthroplasty(THA) with and without femoral osteotomy in Crowe Ⅳ developmental hip dislocation(DDH).
Methods The data on 46 patients who underwent THA for unilateral Crowe Ⅳ DDH between 2012 and 2017 were analyzed retrospectively. They were divided into two groups according to the different surgical methods. There were 24 patients in the osteotomy group,3 males and 21 females,with an average age of (47.3±9.0) years old ranged from 34 to 57 years old;and 22 patients in the non-osteotomy group,2 males and 20 females,with an average age of (51.6±8.3) years old ranged from 40 to 61 years old. The operative time,bleed loss,postoperative drainage volume,postoperative complications,ROM of hip,Harris hip score,limb length discrepancy(LLD),and radiological data were recorded. The femoral dislocation height and the implantation depth of sleeve were measured..
Results All patients were followed up. The mean follow-up time was (3.8±1.2) years ranged from 2 to 6 years in the osteotomy group and (3.2±0.9) years ranged from 1 to 5 years in the non-osteotomy group. The operative time(136.8±18.9) min,bleed loss (709.8±89.4) ml,postoperative drainage volume(308.8±98.2) ml of osteotomy group were all significantly greater than those of non-osteotomy group(100.7±15.8)min,(516.5±103.3) ml,(245.3±79.3) ml (P＜0.05). The Harris score at the latest 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 LLD at last follow up was significantly increased compared with preoperative LLD in two groups,the LLD in non-osteotomy group(0.7±0.2) cm showed signifcant smaller than the two osteotomy group(1.2±0.4) cm. Between osteotomy and non-osteotomy groups,the preoperative range of motion of hip joint[(89.5±19.7) ° vs (102.5±16.8) °],the preoperative height of dislocation of femoral head[(4.56±0.61) cm vs (3.10±0.73) cm],the proximal implant depth of S-ROM[(0.93±0.36) cm vs (1.67±0.28) cm] was significantly different (P＜0.05). Eleven patients in the osteotomy group still had claudication,and 4 patients in the non-osteotomy group had mild claudication (P＜0.05). In non-osteotomy group,3 patients developed nerve injury (1 patient of sciatic nerve,2 patients of femoral nerve) and 1 case developed periprosthetic fracture. In osteotomy group,2 case of dislocation and 2 cases of periprosthetic fractures.
Conclusion Whether osteotomy or not can achieve satisfactory results for treating Crowe type Ⅳ DDH and significantly improve LLD. However,osteotomy is more complex and time-consuming,limb length difference is greater,and the incidence of claudication is higher. Furthermore,patients with smaller preoperative hip mobility,higher femoral dislocation,limb lengthening ≥ 4 cm and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy. |
| KEYWORDS:Developmental dysplasia of the hip Total hip arthroplasty Femoral 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: | 孙博,李科伟,侯颖周,王金良,魏瑄,王少华.Crowe Ⅳ型发育性髋关节脱位全髋关节置换术中股骨截骨与否的对比研究[J].中国骨伤,2024,37(10):972~977 |
| 英文格式: | SUN Bo,LI Ke-wei,HOU Ying-zhou,WANG Jin-liang,WEI Xuan,WANG Shao-hua.Comparative study of total hip arthroplasty with and without femoral osteotomy in Crowe Ⅳ developmental dysplasia of the hip[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(10):972~977 |
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