Çatma Mehmet Faruk, Ünlü Serhan, Öztürk Alper, Aksekili Atıf M, Ersan Önder, Ateş Yalım
Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
Atatürk Training and Research Hospital, Ankara, Turkey.
Int Orthop. 2016 Nov;40(11):2271-2276. doi: 10.1007/s00264-016-3144-0. Epub 2016 Mar 3.
The purpose of this study was to compare two distinct fixation methods for a total hip replacement performed via transverse femoral shortening osteotomy for patients with severe hip dysplasia.
In this retrospective study we compared two fixation methods for total hip replacement of 78 hips in 76 patients exhibiting Crowe type IV developmental hip dysplasia (DDH). The hip replacements were performed via a transverse femoral shortening osteotomy and carried out between September 2009 and December 2013. Group I patients underwent fixation of the shortened femoral segment via a cable attached to the osteotomied segment, and group II patients underwent fixation with a plate and screw. We compared the two techniques based on operating time, osteotomy site union time, Harris hip score, hip loosening signs, and overall clinical outcomes.
The mean operating time for groups I and II was determined to be 116.5 ± 12.8 min and 137.7 ± 14 min, respectively (p < 0.05), while the average union time was 113 ± 51 days for group I and 152 ± 37 days for group II (p < 0.05). Fixation of the femur with a cable (group I) is therefore faster and results in more rapid union time when compared to plate osteosynthesis at the osteotomy site (group II). We observed only one non-union in group I compared with three in group II (p = 0.49). Harris hip scores at the final patient follow-up were 82.8 ± 7.8 and 80.8 ± 6.7 for groups I and II, respectively (p = 0.23). Thus, notably no significant differences were observed between the groups with regard to clinical outcomes such as the Harris hip score or loosening of the replacement components.
Fixation of the removed femoral segment with a cable provided adequate rotational stability and decreased the operating time, leading to early union at the osteotomy site.
本研究旨在比较两种不同的固定方法，用于重度髋关节发育不良患者经股骨横向缩短截骨术进行全髋关节置换。
在这项回顾性研究中，我们比较了76例患有克劳氏IV型发育性髋关节发育不良（DDH）患者的78个髋关节进行全髋关节置换的两种固定方法。髋关节置换通过股骨横向缩短截骨术进行，手术时间为2009年9月至2013年12月。第一组患者通过连接到截骨段的缆线固定缩短的股骨段，第二组患者采用钢板螺钉固定。我们基于手术时间、截骨部位愈合时间、Harris髋关节评分、髋关节松动体征和总体临床结果对两种技术进行了比较。
第一组和第二组的平均手术时间分别确定为116.5±12.8分钟和137.7±14分钟（p<0.05），而第一组的平均愈合时间为113±51天，第二组为152±37天（p<0.05）。因此，与截骨部位的钢板内固定（第二组）相比，用缆线固定股骨（第一组）更快，且愈合时间更短。第一组仅观察到1例骨不连，而第二组为3例（p = 0.49）。在患者最终随访时，第一组和第二组的Harris髋关节评分分别为82.8±7.8和80.8±6.7（p = 0.23）。因此，在Harris髋关节评分或置换部件松动等临床结果方面，两组之间未观察到明显差异。
用缆线固定切除的股骨段可提供足够的旋转稳定性并减少手术时间，导致截骨部位早期愈合。
