Yang Xucheng, Lei Pengfei, Wen Ting, Hu Yihe
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Apr;29(4):439-43.
To assess the effectiveness of two osteotomy methods in total hip arthroplasty (THA) for treating Crowe type IV adult developmental dysplasia of the hip (DDH), trochanteric osteotomy and subtrochanteric osteotomy.
A retrospective analysis was made on the clinical data of 36 patients (43 hips) with Crowe type IV DDH undergoing THA between June 2007 and December 2013. In THA, 19 patients (23 hips) underwent trochanteric osteotomy (group A) and 17 patients (20 hips) underwent subtrochanteric osteotomy (group B). There was no significant difference in age, gender, body mass index, side, preoperative Harris score, and limb length difference between 2 groups (P>0.05). The operation duration, bleeding volume, hospitalization duration, intraoperative and postoperative complications were compared between 2 groups.
There was no significant difference in operation duration, bleeding volume, and hospitalization days between 2 groups (P>0.05). The rate of intraoperative complication was 21.7% (5/23) in group A and 5.0% (1/20) in group B, showing no significant difference between 2 groups (P>0.05). The rate of postoperative complications was 10.5% (2/19) in group A and 22.2% (4/18) in group B, showing no significant difference between 2 groups (P>0.05). Thirty-one patients (37 hips) were followed up 1-7 years (mean, 3 years), including 16 cases (19 hips) in group A and 15 cases (18 hips) in group B. X-ray films showed good position of the prostheses. The Harris score at last follow-up was significantly increased when compared with preoperative score in 2 groups (P<0.05), but there was no significant difference between 2 groups (P>0.05). The postoperative discrepancy of bilateral lower limbs had no significant difference (t = -1.343, P=0.188).
THA with trochanteric osteotomy or subtrochanteric osteotomy both can effectively treat Crowe type IV DDH. THA with subtrochanteric osteotomy has an advantage in correcting lower limb discrepancy.
评估转子下截骨术和股骨转子下截骨术这两种截骨方法在全髋关节置换术（THA）治疗Crowe IV型成人发育性髋关节发育不良（DDH）中的有效性。
回顾性分析2007年6月至2013年12月期间接受THA治疗的36例（43髋）Crowe IV型DDH患者的临床资料。在THA中，19例患者（23髋）接受转子下截骨术（A组），17例患者（20髋）接受股骨转子下截骨术（B组）。两组患者在年龄、性别、体重指数、患侧、术前Harris评分和肢体长度差异方面无显著差异（P>0.05）。比较两组患者的手术时间、出血量、住院时间、术中及术后并发症。
两组患者的手术时间、出血量和住院天数无显著差异（P>0.05）。A组术中并发症发生率为21.7%（5/23），B组为5.0%（1/20），两组间无显著差异（P>0.05）。A组术后并发症发生率为10.5%（2/19），B组为22.2%（4/18），两组间无显著差异（P>0.05）。31例患者（37髋）接受了1至7年（平均3年）的随访，其中A组1实6例（19髋），B组15例（18髋）。X线片显示假体位置良好。两组患者末次随访时的Harris评分与术前评分相比均显著提高（P<0.05），但两组间无显著差异（P >0.05）。术后双侧下肢差异无显著差异（t = -1.343，P = 0.188）。
转子下截骨术或股骨转子下截骨术的THA均能有效治疗Crowe IV型DDH。股骨转子下截骨术的THA在纠正下肢差异方面具有优势。
