Kohlhof H, Ziebarth K, Gravius S, Wirtz D C, Siebenrock K A
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Siegmund-Freud-Str. 25, 53127, Bonn, Deutschland,
Oper Orthop Traumatol. 2013 Oct;25(5):469-82. doi: 10.1007/s00064-013-0241-8. Epub 2013 Oct 2.
The aim of the therapy is mechanical and functional stabilization of high dislocated hips with dysplasia coxarthrosis using total hip arthroplasty (THA).
Developmental dysplasia of the hip (DDH) in adults, symptomatic dysplasia coxarthrosis, high hip dislocation according to Crowe type III/IV, and symptomatic leg length inequality.
Cerebrospinal dysfunction, muscular dystrophy, apparent disturbance of bone metabolism, acute or chronic infections, and immunocompromised patients.
With the patient in a lateral decubitus position an incision is made between the anterior border of the gluteus maximus muscle and the posterior border of the gluteus medius muscle (Gibson interval). Identification of the sciatic nerve to protect the nerve from traction disorders by visual control. After performing trochanter flip osteotomy, preparation of the true actetabulum if possible. Implantation of the reinforcement ring, preparation of the femur and if necessary for mobilization, resection until the trochanter minor. Test repositioning under control of the sciatic nerve. Finally, refixation of the trochanteric crest.
During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with maximum flexion of 70°. No active abduction and passive adduction over the body midline. Maximum weight bearing 10-15 kg for 8 weeks, subsequently, first clinical and radiographic follow-up and deep venous thrombosis prophylaxis until full weight bearing.
From 1995 to 2012, 28 THAs of a Crow type IV high hip-dislocation were performed in our institute. Until now 14 patients have been analyzed during a follow-up of 8 years in 2012. Mid-term results showed an improvement of the postoperative clinical score (Merle d'Aubigné score) in 86 % of patients. Good to excellent results were obtained in 79 % of cases. Long-term results are not yet available. In one case an iatrogenic neuropraxia of the sciatic nerve was observed and after trauma a redislocation of the arthroplasty appeared in another case. In 2 cases an infection of the THA appeared 8 and 15 months after index surgery. No pseudoarthrosis of the trochanter or aseptic loosening was noticed.
该治疗的目的是通过全髋关节置换术（THA）对伴有发育性髋关节病的高位脱位髋关节进行机械和功能稳定。
成人髋关节发育不良（DDH）、有症状的发育性髋关节病、根据克劳氏（Crowe）III/IV型的高位髋关节脱位以及有症状的下肢长度不等。
脑脊液功能障碍、肌肉萎缩症、明显的骨代谢紊乱、急慢性感染以及免疫功能低下患者。
患者取侧卧位，在臀大肌前缘与臀中肌后缘之间（吉布森间隙）做切口。识别坐骨神经，通过视觉控制保护神经免受牵拉损伤。进行转子翻转截骨术后，尽可能准备真髋臼。植入加强环，准备股骨，如有必要为便于活动，切除至小转子。在坐骨神经控制下进行试验性复位。最后，重新固定转子嵴。
住院期间，使用连续被动运动机对髋关节进行强化活动，最大屈曲度为70°。禁止主动外展和在身体中线以上被动内收。8周内最大负重10 - 15千克，随后进行首次临床和影像学随访以及预防深静脉血栓形成，直至完全负重。
1995年至2012年，我院对28例克劳氏IV型高位髋关节脱位患者进行了全髋关节置换术。截至2012年，在8年的随访期间对14例患者进行了分析。中期结果显示，86%的患者术后临床评分（默尔·德奥布涅评分）有所改善。79%的病例获得了良好至优秀的结果。尚无长期结果。1例患者出现坐骨神经医源性神经失用，另1例患者在创伤后出现人工关节再脱位。2例患者在初次手术后8个月和15个月出现全髋关节置换术感染。未发现转子假关节或无菌性松动。
