不同程度髋关节发育不良继发骨性关节炎的全髋关节置换术疗效分析△

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1、不同程度髋关节发育不良继发骨性关节炎的全髋关节置换术疗效分析△作者：刘瑞宇，王坤正，王春生，党晓谦，同志勤【摘要】［目的］探讨全髋关节置换术治疗髋关节发育不良继发骨性关节炎的术后效果及髋关节发育不良的严重程度对手术疗效的影响。［方法］对47例（55髋）髋关节发育不良继发骨性关节炎的患者进行全髋关节置换术。其中CroweⅠ型23髋;Ⅱ型19髋；Ⅲ/Ⅳ型共13髋。术前应用影像学方法评估髋臼和股骨的形态学变化，术中髋臼重建在真臼位置，逐渐扩大股骨髓腔，选用细而直的股骨假体。术前和术后对术侧髋关节行Harris髋关节评分。［结果］Ⅰ、Ⅱ和Ⅲ/Ⅳ型患者Harris髋关节评分分别由术前的5

2、0.7±7.6、44.9±6.2和41.1±8.2增加到术后的90.6±3.7、87.3±4.5和82.7±7.3，和术前比较有显著性差异（P<0.05）。Harris髋关节评分分级显示，Ⅰ、Ⅱ和Ⅲ/Ⅳ型髋关节术后分级在良以上的关节分别占本组髋关节的100%、100%和69%，优分别为70%、53%和31%。随访23～81个月，平均45个月，关节假体稳定，关节功能正常。［结论］全髋关节置换术是治疗髋关节发育不良继发骨性关节炎的有效方法，CroweⅠ和Ⅱ型患者术后效果优于Ⅲ/Ⅳ型。【关键词】髋关节发育不良；全髋置换；疗效分析10Abstract:［Objective］Toe

3、xploretheresultoftotalhiparthroplasty(THA)performedinpatientswithosteoarthritissecondarytodevelopmentaldysplasiaofthehip(DDH)andthedegreeofhipdysplasiaonthetreatmentresult.［Method］Forty-sevencases(55hips)withosteoarthritissecondarytoDDHweretreatedwithTHA.AccordingtotheclassificationofCrowe,2

4、3hipswereinclassⅠ,19inclassⅡand13inclassⅢ/Ⅳ.Beforeoperation,themorphologicalchangesofacetabulaandfemurswereevaluatedwithhelicalCT.Duringtheoperation,theacetabulawerereconstructedatthelevelofrealacetabula,thefemoralcanalwascarefullyenlargedandthesmallandstraightfemoralprotheseswereemployed.Th

5、eHarrishipscorewasconductedineachpatientspreoperativelyandpostoperatively.［Result］TheHarrishipscoreinclassⅠ,ⅡandⅢ/Ⅳwerefrom50.7±7.6,44.9±6.2and41.1±8.2preoperativeto90.6±3.7,87.3±4.5and82.7±7.3postoperative,respectively.Therewassignificantdifferencebetweenthem（P<0.05）.PostoperativeHarrish

6、ipscoregradingshowedthattherateofexcellenceinclassⅠ,ⅡandⅢ/Ⅳwere100%,100%and69%andtherateofgoodwere70%,53%and31%respectively.Afterthefollow-upof23-81months(mean45months),therewasnoprosthesislooseningandthehipfunction10wasgood.［Conclusion］Totalhiparthroplastyisafeasiblemethodtotreatosteoarthri

7、tissecondarytoDDH.ItsresultinclassⅠandⅡarebetterthanthatinclassⅢ/Ⅳ.Keywords：developmentaldysplasiaofthehip;totalhiparthroplasty;operationresult髋关节发育不良的患者晚期会发生骨性关节炎。患髋疼痛，行走跛行，严重影响患者的生活。既往对该类患者多施行关节成形术来缓解疼痛，但该手术有限制关节的活动及影响患者生活质量等局限性。全髋关节置换术不但可彻底去除髋关节