Kobayashi Seneki, Saito Naoto, Nawata Masashi, Horiuchi Hiroshi, Iorio Richard, Takaoka Kunio
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Bone Joint Surg Am. 2003 Apr;85(4):615-21. doi: 10.2106/00004623-200304000-00005.
The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure.
Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four.
Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation.
We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.
对于发育性髋关节发育不良患者，采用骨水泥固定并使用大块自体骨移植进行髋臼重建的全髋关节置换术的长期效果差异很大。我们评估了采用髋臼大块自体骨移植的全髋关节置换术的结果，以确定影响该手术效果的因素。
在采用Charnley技术和假体进行全髋关节置换术时，用大块股骨头自体骨移植重建因发育性髋关节发育不良导致的髋臼顶缺损。对30例患者（手术时平均年龄57岁）的37个髋关节进行了10至26年（平均19年）的随访。髋关节半脱位或脱位的Crowe分类为：16个髋关节为II组，17个为III组，4个为IV组。
移植骨对髋臼的覆盖范围为5%至49%（平均33%）。29个髋臼位于真髋臼内，8个位置更靠近近端。在最近一次随访时，所有患者的临床结果均为优，所有移植骨均已愈合，且没有髋关节有影像学证据显示固定失败。
我们发现，对于48岁及以上因发育性髋关节发育不良导致严重骨缺损的髋臼，采用骨水泥固定并使用大块自体骨移植进行全髋关节置换术，当移植骨对髋臼的覆盖不超过50%时可获得长期成功。当在真髋臼水平无法实现髂骨对髋臼>50%的覆盖时，建议将髋臼更靠近近端放置以获得足够的覆盖。
