全髋关节置换治疗成人发育性髋关节脱位临床的研究 (1)

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1、提要目的：探讨成人发育性髋关节脱位的全髋关节置换术的手术要点和术后疗效。方法：采用人工全髋关节假体，对21例23髋成人发育性髋关节脱位患者进行了全髋关节置换术，重建髋臼及股骨的解剖结构，正确安装假体。其中男2例，女19例。年龄35～73岁，平均51岁。双侧2例，单侧19例。主要症状为疼痛及跛行。根据CroweX线分型，Ⅰ型9髋，Ⅱ型6髋，Ⅲ型5髋，Ⅳ型3髋。结果：随访6个月～6年，术前Harris评分最高分69.925，最低分22.35，平均分47.411。所有患者术后髋关节疼痛消失，关节活动度增加

2、，Harris评分最高分98.75，最低分71.15，平均分90.738。优13髋、良8髋、可2髋，优良率为91.30％。结论：成人发育性髋关节脱位采用全髋关节置换是有效的治疗方法，手术相对比较复杂并发症较多，手术中特别需要考虑两侧肢体的长度、外展肌的平衡、软组织的松解、髋臼骨缺损的处理及假体的选择，配合术中的正确操作能简化手术，减少并发症，提高疗效。关键词成人发育性髋关节脱位；全髋关节置换；临床研究ClinicalResearchofTheManagementoftheDevelopmentalD

3、islocationHipwithTotalHipReplacementSpeciality:OrthopaedicsofTCMAuthor:MaCunyiTutor:ZhangShihuaAbstractObjective:Tostudythesurgicalprocedureanditspostoperativeeffectivenessoftotalhipreplacement（THR）fortreatmentofdevelopmentaldislocationofhip（DDH）.Metho

4、ds:21casesof23modelhipadultdevelopmentdislocationhipwithsecondarybonejointinflammtionweretakenfortotalhipreplacementandrebuiltdissectionstructureoftheacetabulumandfemurandrightlyinstalledartificialstyle.Amongthepatients,2weremaleand19werefemale.Withthe

5、iragesrangingfrom35to73yearsandanaverageageof51years.Thebilateralarthroplastywasperformedin2patientsandtheunilateralarthroplastyin19patients.Thepatientsmainlysufferedfrompainandclaudication.AccordingtoCroweclassification,9weretypeⅠ,6typeⅡ,5typeⅢand3typ

6、eⅣ.Result:Thefollowed—uptimewasfrom0.5to6years.ThepreoperativeHarrishipscorerangedfrom22.35to69.925（average47.411）.Aftertheoperation,thepainwascompletelyrelievedandtheHarrishipscorerangedfrom71.15to98.75（average90.738）.13caseswereexcellent,8caseswerego

7、odand2caseswerefair.Therateofexcellentandgoodwas91.30％.Conclusion:Treatmentoftotalhipreplacementtoadultdevelopmentaldislocationofthehipisaeffectiveway,anditcouldbesomewhatdifficult,becauseoftheliabilitytocomplications.Thetechnicaldifficultiesencountere

8、dduringsurgeryincludedthecorrectionofthelengthofbilaterallowerextremity,thebalanceoftheabductormuscles,thereleaseofthesofttissue,thedea1ingofthesuperiorseganentaldefectofacetabulumandselectionofthecomponents,andgoodperformancecanmakethe