Hoekman Patrick, Idé Garba, Kassoumou Akambi Sanoussi, Hayatou Mahamadou Malam
Department of Orthopaedic Surgery, National Hospital of Niamey, Niamey, Niger, Africa.
PLoS One. 2014 Jan 20;9(1):e85868. doi: 10.1371/journal.pone.0085868. eCollection 2014.
In developing countries hip osteoarthritis constitutes a major public health issue as it is highly prevalent in all age ranges of population, including the young. It often remains untreated because of the low accessibility of total hip prostheses. Hip arthrodesis still represents a major treatment option, but, for several reasons which are discussed in this paper, is nowadays infrequently performed. By means of reporting the results of a new simple technique, using a self-devised plate, the relevancy of hip arthrodesis in this particular environment is emphasized.
Our series included 35 patients with painful hip osteoarthritis who underwent a hip fusion with the anterolateral arthrodesis plate. Two of them had a concurrent femoral osteotomy for correction of a vicious position of the limb and another patient had a femoral diaphysis osteotomy and placement of a Wagner elongating device in order to proceed with a limb lengthening by callotasis. The follow-up period averaged 16,9 months (9 to 34). All hips, except two, achieved solid fusion between 6 and 15 months after surgery. One failure of fusion was in the oldest patient, who presented a loosening of plate and screws due to an advanced degree of osteoporosis; the other was in a young patient who admitted having walked on his leg too soon. Patient satisfaction was high. We concluded that this technique is reliable and effective.
The results of this study should convince the hesitant surgeon and patient to consider hip arthrodesis an acceptable treatment option for disabling hip arthritis, compared to no treatment at all.
在发展中国家，髋骨关节炎是一个重大的公共卫生问题，因为它在包括年轻人在内的所有年龄段人群中都高度流行。由于全髋关节假体的可及性低，该病常常得不到治疗。髋关节融合术仍然是一种主要的治疗选择，但由于本文中讨论的几个原因，如今很少实施。通过报告一种使用自行设计的钢板的新的简单技术的结果，强调了髋关节融合术在这种特殊环境中的相关性。
我们的系列研究纳入了35例有症状的髋骨关节炎患者，他们接受了前路外侧融合钢板的髋关节融合术。其中2例同时进行了股骨截骨术以矫正肢体的不良位置，另1例患者进行了股骨干截骨术并放置了瓦格纳延长装置，以便通过骨痂延长术进行肢体延长。随访期平均为16.9个月（9至34个月）。除2例之外，所有髋关节在术后6至15个月实现了牢固融合。1例融合失败发生在年龄最大的患者，由于骨质疏松程度严重，出现了钢板和螺钉松动；另1例发生在一名年轻患者，该患者承认过早负重行走。患者满意度较高。我们得出结论，该技术可靠且有效。
本研究结果应能说服犹豫不决的外科医生和患者，相较于完全不治疗，髋关节融合术是治疗致残性髋关节炎的一种可接受的治疗选择。
