Wu Li-Dong, Jin Li-Bin, Yan Shi-Gui, Yang Quan-Sen, Dai Xue-Song, Wang Xiang-Hua
Department of Orthopaedics, Second Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310009, China.
Chin J Traumatol. 2004 Oct;7(5):280-5.
To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis.
Between 1995 and 2002, we implanted 23 cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18 females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with a cementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabulum and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31% (ranging from 10% to 45%). Eight hips had less than 25% cup coverage and thirteen between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years). The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made.
All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia. After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1 Brooker heterotopic ossification and one developed Grade 2.
THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in patients with developmental hip dysplasia when the cementless cup covered by the graft does not exceed 50%.
评估采用非骨水泥髋臼杯及自体股骨头移植对髋臼发育不良合并骨关节炎患者行全髋关节置换术（THA）的疗效。
1995年至2002年间，我们对20例髋臼发育不良合并骨关节炎患者植入了23个非骨水泥髋臼杯及进行了自体股骨头移植。本研究对20例（18例女性，2例男性，平均年龄50岁）采用非骨水泥髋臼杯及自体股骨头移植行THA治疗的发育性髋关节发育不良患者的21个髋关节进行了回顾性研究。髋臼杯置于真髋臼水平，由于髋臼缺损，所有患者均需自体股骨头移植。自体股骨头移植覆盖髋臼杯的平均比例为31%（范围为10%至45%）。8个髋关节的髋臼杯覆盖率低于25%，13个髋关节的覆盖率在25%至50%之间。平均随访期为4.7年（范围1至8年）。采用改良Harris髋关节评分评估置换效果。拍摄术前及随访X线片。
所有移植骨均与宿主骨愈合。所有患者中均未出现移植骨塌陷或髋关节假体松动。根据改良Harris髋关节评分，平均髋关节评分从术前的46分提高到末次复查时的89分。术前，除1例双侧髋关节发育不良患者外，所有患者的下肢长度差异均大于2 cm。术后，20例患者中仅有2例下肢长度差异大于1 cm。3个髋关节在移植骨外侧部分出现轻微骨吸收，未对髋臼杯起到支撑作用。3个髋关节发生1级布鲁克异位骨化，1个髋关节发生2级。
对髋臼发育不良所致骨关节炎患者采用非骨水泥髋臼杯及自体股骨头移植行THA可取得良好疗效。当移植骨覆盖的非骨水泥髋臼杯不超过50%时，该方法可为发育性髋关节发育不良患者提供可靠的髋臼固定并恢复髋臼骨量。
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