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全髋关节置换术中解剖型股骨组件假体治疗重度发育性髋关节发育不良的疗效

[EFFECTIVENESS OF ANATOMIC FEMORAL COMPONENT PROSTHESIS FOR SEVERE DEVELOPMENTAL DYSPLASIA OF THE HIP IN TOTAL HIP ARTHROPLASTY].

作者信息

An Xiao, Dong Jiyuan, Gong Ke, Zhang Qi, Li Xiang, Song Wei

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Apr;29(4):431-4.

Abstract

OBJECTIVE

To evaluate the effectiveness of anatomic femoral component prosthesis for severe development dysplasia of the hip (DDH) in total hip arthroplasty (THA).

METHODS

Between September 2009 and September 2013, 48 patients (51 hips) with severe DDH underwent THA with cementless anatomic femoral component prosthesis. There were 5 males (5 hips) and 43 females (46 hips) with an average age of 51 years (range, 28-67 years). The left hip was involved in 25 cases, the right hip in 20 cases, and bilateral hips in 3 cases. There were 39 cases (44 hips) of Crowe type III and 9 cases (7 hips) of Crowe type IV. The visual analogue scale (VAS) score was 5.72 +/- 1.84, and Harris score was 41.66 +/- 4.87 at preoperation. All patients had leg discrepancy with a length difference of (4.31 +/- 0.84) cm.

RESULTS

The duration of surgery was 59-110 minutes (mean, 78.6 minutes), and the hospitalization days were 6-20 days (mean, 12.3 days). All patients obtained primary healing of incision without wound related complications of swelling, effusion, and infection. Two patients were found to have intramuscular venous thrombosis. All patients were followed up 10-54 months (mean, 29 months). Limp was observed at the early stage after operation in 9 patients and disappeared after 1 year, the other patients had normal gait. The VAS score 1.46?0.47, Harris score 88.66 +/- 3.48, and the leg length difference (1.15 +/- 0.33) cm at last follow-up all showed significant differences when compared with the preoperative values (P<0.05). No prosthesis loosening or subsidence, heterotopic ossification, dislocation, and infection occurred.

CONCLUSION

Anatomic femoral component prosthesis for severe DDH in THA can relieve pain, and improve the hip joint function and limb discrepancy. Short-term effectiveness was satisfactory, but the long-term effectiveness should still be observed in future.

摘要

目的

评估解剖型股骨组件假体在全髋关节置换术(THA)中治疗重度发育性髋关节发育不良(DDH)的有效性。

方法

2009年9月至2013年9月,48例(51髋)重度DDH患者接受了非骨水泥解剖型股骨组件假体的THA手术。其中男性5例(5髋),女性43例(46髋),平均年龄51岁(范围28 - 67岁)。左侧髋关节受累25例,右侧髋关节受累20例,双侧髋关节受累3例。Crowe III型39例(44髋),Crowe IV型9例(7髋)。术前视觉模拟评分(VAS)为5.72±1.84,Harris评分为41.66±4.87。所有患者均存在下肢不等长,长度差为(4.31±0.84)cm。

结果

手术时间为59 - 110分钟(平均78.6分钟),住院天数为6 - 20天(平均12.3天)。所有患者切口均一期愈合,无伤口相关并发症如肿胀、积液及感染。发现2例患者有肌内静脉血栓形成。所有患者均随访10 - 54个月(平均29个月)。9例患者术后早期出现跛行,1年后消失,其他患者步态正常。末次随访时VAS评分为1.46±0.47,Harris评分为88.66±3.48,下肢长度差为(1.15±0.33)cm,与术前值相比均有显著差异(P<0.05)。未发生假体松动或下沉、异位骨化、脱位及感染。

结论

解剖型股骨组件假体用于THA治疗重度DDH可缓解疼痛,改善髋关节功能及下肢不等长情况。短期疗效满意,但长期疗效仍有待进一步观察。

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