Shi Zhen-cai, Li Zi-rong, Sun Wei
Department of Orthopedics, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Wai Ke Za Zhi. 2004 Dec 7;42(23):1412-5.
To explore the correct localization of the acetabular component, surgical technique and the outcome in total hip arthroplasty (THA) for acetabular dysplasia with secondary osteoarthritis.
A retrospective review was undertaken of 44 hips (38 patients) that had had a total hip arthroplasty for acetabular dysplasia with secondary osteoarthritis from September.1989 to April. 2003. 14 were male (one bilateral) and 24 patients were female (5 bilateral). The mean duration of clinical and roentgenographic follow-up was thirty-six months (range, eight to one hundred and sixty-eight months), and the mean age of the patients was fifty-one years (range, twenty-nine to eighty years). Twelve hips were classified as type I; twenty-four as type II; seven as type III; and one as type IV, according to the criteria of Crowe. The horizontal location of the center of the hip (the distance along the interior drop line extending lateral or medial from the inferior point of the teardrop to the perpendicular line dropped from the center of the femoral head) was measured.
There were 24 acetabular components that were placed in the centralized position and the other 20 in no deepen placement post-operatively. At the most recent follow-up, the mean Harris hip score was 90.2, 86.3 for the centralized position and the undeepen placement hips respectively, there was a significant difference between these two groups.
In order to obtain the stability of acetabular component, deepen acetabular reaming is necessary for the most acetabular dysplasia in THA. In this way the anatomical rotational center can be obtained medially and lowly. The excellent long-term function will be maintained.
探讨髋臼发育不良继发骨关节炎行全髋关节置换术(THA)时髋臼假体的正确定位、手术技术及疗效。
回顾性分析1989年9月至2003年4月间因髋臼发育不良继发骨关节炎行全髋关节置换术的44例髋关节(38例患者)。男性14例(1例双侧),女性24例(5例双侧)。临床及影像学随访的平均时间为36个月(范围8至168个月),患者的平均年龄为51岁(范围29至80岁)。根据Crowe标准,12例髋关节为I型;24例为II型;7例为III型;1例为IV型。测量髋关节中心的水平位置(沿泪滴最低点向外侧或内侧延伸至股骨头中心垂线的内移线距离)。
术后24个髋臼假体置于中心位置,另外20个未进行加深处理。在最近一次随访时,Harris髋关节平均评分分别为:中心位置组90.2分,未加深处理组86.3分,两组间差异有统计学意义。
为获得髋臼假体的稳定性,对于大多数髋臼发育不良的THA患者,加深髋臼磨锉是必要的。如此可在内侧及低位获得解剖旋转中心,并维持良好的长期功能。