Holzapfel B M, Bürklein D, Greimel F, Nöth U, Hoberg M, Gollwitzer H, Rudert M
Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Brettreichstr. 11, 97074 Würzburg, Deutschland.
Orthopade. 2011 Jun;40(6):543-53. doi: 10.1007/s00132-011-1754-1.
Total hip arthroplasty is the procedure of choice for most patients with advanced, symptomatic osteoarthritis due to congenital dysplasia of the hip. However, the complexity of arthroplasty is significantly increased because of anatomic abnormalities associated with dysplasia of the hip. In addition the relatively young age of patients may affect survival of the implant. From a biomechanical standpoint the primary surgical objective is reconstruction of the anatomical center of rotation. Independent of the pelvic bone stock the socket should be located as near as possible to the anatomical acetabular location. There are various operative strategies to ascertain sufficient stability of the socket. The anterolateral deficiency of the acetabulum can be reconstructed by bulk femoral autografting or bone impaction grafting. Furthermore controlled perforation of the medial wall or implantation of reinforcement rings and oval sockets have been described. Cementless, biological socket fixation shows superior long-term results compared to cemented cups, especially in these young patients. The location of the reconstructed acetabulum and the desired leg length influence the type of femoral reconstruction and in some cases femoral shortening is required. In this article endoprosthetic reconstructive options for developmental dysplasia of the hip are discussed depending on the femoral and acetabular deformity.
对于大多数因先天性髋关节发育不良而患有晚期症状性骨关节炎的患者来说，全髋关节置换术是首选的治疗方法。然而，由于与髋关节发育不良相关的解剖学异常，关节置换术的复杂性显著增加。此外，患者相对年轻的年龄可能会影响植入物的使用寿命。从生物力学角度来看，主要的手术目标是重建解剖旋转中心。无论骨盆骨量如何，髋臼杯都应尽可能靠近解剖学髋臼位置。有多种手术策略可确保髋臼杯有足够的稳定性。髋臼前外侧缺损可通过大块自体股骨移植或骨打压植骨来重建。此外，还描述了对髋臼内壁进行控制性穿孔或植入加强环和椭圆形髋臼杯的方法。与骨水泥固定髋臼杯相比，非骨水泥生物髋臼固定显示出更好的长期效果，尤其是在这些年轻患者中。重建髋臼的位置和期望的肢体长度会影响股骨重建的类型，在某些情况下需要进行股骨缩短。在本文中，将根据股骨和髋臼畸形情况讨论髋关节发育不良的假体重建选择。
