Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2010 Sep;92 Suppl 1 Pt 2:176-87. doi: 10.2106/JBJS.J.00061.
When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.
In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively.
The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified.
Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis.
当外科医生为髋关节发育性脱位相关的高位脱位患者进行全髋关节置换术时，获得长期稳定的植入物固定并优化患者功能仍然是挑战。本文旨在评估一组 Crowe Ⅳ型发育性髋关节发育不良患者行非骨水泥关节置换术联合转子下短缩截骨术的结果。
在一项回顾性研究中，我们评估了 24 例（20 名女性和 4 名男性）连续 28 例初次非骨水泥全髋关节置换术的结果和并发症，所有患者均为 Crowe Ⅳ型发育性髋关节发育不良。关节置换术与转子下短缩截骨术联合进行，髋臼组件放置在解剖髋关节中心水平。患者术后平均随访 4.8 年。
术前平均 Harris 髋关节评分为 43 分，末次随访时增加至 89 分（p<0.01）。28 髋中有 12 髋（43%）发生早期或晚期并发症或再次手术。28 例转子下截骨术中有 2 例（7%）发生不愈合。股骨柄单独松动 1 例。髋臼组件松动 1 例，髋臼衬垫脱位 1 例。术后 4 髋脱位。末次放射随访时所有剩余组件均固定良好。未发现坐骨神经损伤。
对于髋关节发育性脱位导致高位脱位的患者，行非骨水泥全髋关节置换术联合转子下股骨短缩截骨术，术后可获得较高的植入物固定成功率和截骨愈合率，术后平均 Harris 髋关节评分为 89 分。然而，并发症发生率明显高于退行性关节炎患者的初次全髋关节置换术。
