刘福存 华江 任洁 邹建琴 童培建

全髋关节置换联合髋臼造盖术治疗CroweIII型发育性髋关节脱位的疗效观察

刘福存 华江 任洁 邹建琴 童培建

目的 评估全髋关节置换联合髋臼造盖术治疗CroweIII型发育性髋关节脱位（DDH）的疗效。方法 以行全髋关节置换联合髋臼造盖术的18例CroweIII型DDH患者为研究对象，采用Harris髋关节评分（HHS）、骨关节炎指数可视化量表评分（WOMAC）评价手术前后临床疗效，影像学评估内容包括髋臼前倾角和假体位移。结果 术后12～42个月的随访期间未发生深部感染、脱位和无菌性松动等。HSS评分由术前（38.6±12.3）分升高至术后（90.3±17.5）分，差异有统计学意义（P＜0.01）；髋关节优良率为94.4%（17/18）。WOMAC评分由术前（60.3±14.5）分降低至术后（28.3±10.1）分，差异有统计学意义（P＜0.01）。术后股骨假体前倾角13°～50°，平均（31.6±20.4）°；股骨柄与髋臼前倾角之和为26°～74°，其中40°～60°占83.3%。结论 全髋关节置换联合髋臼造盖术可用于CroweIII型DDH患者重建髋关节力学机制，术后髋关节功能恢复良好。

发育性髋关节脱位 全髋关节置换术 髋臼造盖术 植骨

【 Abstract】 Objective To evaluate the short-term efficacy of total hip arthroplasty with hip-shelf procedure for Crowe III developmental dysplasia of the hip(DDH). Methods Eighteen patients with Crowe III DDH were treated by total hip arthroplasty with hip-shelf procedure.Harris hip score(HHS)and western ontario and mcmaster universities osteoarthritis index(WOMAC) score were used for evaluation before and after surgery.Radiographs were used for evaluation of cup anteversion and loosening. Results There were no deep infection,aseptic loosening and dislocation during 12-24 months follow-up period.The average HHS before and after surgery was 38.6±12.3 and 90.3±17.5,respectively(P＜0.01),with a excellent or good rate of 94.4%. WOMAC score decreased from 60.3±14.5 preoperatively to 28.3±10.1 at final follow-up (P＜0.01).The mean preoperative femoralanteversion was 31.6°±20.4°(13°～50°).The sum ofstem anteversion and cup ranged 26°～74°,and in 83.3%patients that was 40°～60°. Conclusion Total hip arthroplasty with hip-shelf procedure may provide excellent results for Crowe III developmentaldysplasia ofthe hip.

CroweⅢ型是发育性髋关节脱位（developmental dysplasia of the hip，DDH）中关节畸形严重且手术难度较高的一种类型。CroweⅢ型DDH患者股骨头完全脱出髋臼，髋臼发育失常，往往小而浅，真臼周围骨量明显不足；股骨头较小，股骨颈细而短，干骺端旋转畸形严重；髋关节周围软组织挛缩，周围神经血管失去了正常的解剖位置[1-2]。随着年龄增高，一旦继发髋关节骨关节炎，则会疼痛难忍，生活质量明显降低。全髋关节置换术是治疗DDH继发髋关节骨关节炎的有效手段[3]，其手术目的是消除疼痛、重建髋关节的力学机制。……