DDH-THA-China--先天性髋关节脱位的髋关节置换.ppt

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1、THAFORDEVELOPMENTALHIPDYSPLASIADanielJ.Berry,MDMayoClinicRochester,MN,USATHAFORDYSPLASIAProblemtoOvercomeonAcetabulumProblem:LateralacetabularbonedeficiencyofvaryingseverityTHAFORDYSPLASIA/LOWDDHACETABULARRECONSTRUCTIONTHAFORDYSPLASIA/LOWDDHAcetabularReconstructionGeneralPrincip

2、les:UncementedsocketOptimizecupstabilityonhostboneDon’tletbonedeficiencydictatecuppositionTHAFORDYSPLASIA/LOWDDHAcetabularReconstructionKeyPoint:UsesupplementalscrewsAvoidpressfitfixationalonewithoutscrewsindeficientacetabulumTHAFORDYSPLASIA/LOWDDHAcetabularReconstructionTechnique

3、ofarthroplastyisdeterminedbyseverityofantero-lateralacetabularbonelossTHAFORDYSPLASIA/LOWDDHAcetabularReconstructionMildLateralDeficiency:Routineacetabularreconstruction(uncemented)SlightmedializationofcupifnecessaryAcceptslightlateraluncoverageTHAFORDYSPLASIA/LOWDDHAcetabularRecon

4、structionModerateLateralDeficiency:MedializehipcentertomedialwallAcceptsomelateraluncoverage(~1.5cmofcup)AcceptslightelevationofhipcenterMarkedLateralDeficiency:Options:MedializethroughmedialwallHighhipcenterLateralbulkautogenousfemoralheadgraftTHAFORDYSPLASIA/LOWDDHAcetabularReco

5、nstructionMANAGEMENTOFTHEDYSPLASTICHIPAcetabularReconstructionMypreference:Medializeto(butnotthrough)medialwallAcceptslightelevationofhipcenterLateralfemheadgraftifneededHighhipcenteronlyinrarecases10yrs,bonerestoredFEMORALHEADAUTOGRAFTSSlightExtrawork,ExtraRiskTheydobankboneforfut

6、ureTHAINDEVELOPMENTALDYSPLASIAAcetabularReconstructionHighDislocationFalseAcetabulumNotthickorwideenoughforcupfixationTrueAcetabulumThickerbonePosteriorcolumn:bestboneTHAINDEVELOPMENTALDYSPLASIAAcetabulum:ReconstructatanatomiccenterSmallcup,22mheadNograft(usually)Technicaltips:-ope

7、nsocketwithburr-reaminreverseTHAFORDYSPLASIA/LOWDDHConclusionsAcetabularreconstructioninhipdysplasia:UncementedcupSupplementalscrewsJudiciousmedializationStructuralgraftonlywhennecessaryTHAFORDEVELOPMENTALHIPDYSPLASIA:THEFEMORALSIDEDanielJ.Berry,MDMayoClinicRochesterMNTHAFORDYSPLA

8、SIAProblemstoOvercomeonFe