Rollo Giuseppe, Solarino Giuseppe, Vicenti Giovanni, Picca Girolamo, Carrozzo Massimiliano, Moretti Biagio
Orthopedics and Traumatology Department, Vito Fazzi Hospital, Piazzetta Muratore, 73100, Lecce, Italy.
Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery Policlinico di Bari, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
J Orthop Traumatol. 2017 Dec;18(4):407-413. doi: 10.1007/s10195-017-0466-7. Epub 2017 Jul 24.
Total hip replacement for high dislocation of the hip presents some difficulties, considering patients' young ages, the abnormal hip anatomy and the high rate of complications. In this study, we present our experience in terms of clinical and radiological results in the treatment of Crowe type IV hips with subtrochanteric femoral shortening osteotomy and cementless total hip replacement.
We retrospectively reviewed 15 patients with Crowe type IV hip dysplasia (two bilateral cases for a total of 17 hips) treated with cementless total hip replacement associated with shortening subtrochanteric osteotomies (nine transversal and eight Z-shape osteotomies) between March 2000 to February 2006. The mean follow-up was 88 months (range 63-133). Harris hip score, leg length discrepancy, neurological status, union status of the osteotomy and the component stability were the criteria of the evaluation. All complications were noted.
The mean HHS improved from 38.3 (range 32-52) to 85.6 (range 69-90). The mean preoperative leg length discrepancy was of 45 mm (range 38-70) and reduced to a mean of 12 mm (range 9-1.6) postoperatively. All osteotomies resulted healed at an average of 12.3 weeks (range 10-15). No cases of delayed union or nonunion were detected. Two patients (11%) showed early symptoms of sciatic nerve palsy which resolved uneventfully in 6 months. There was no migrations and none of the implants required revision.
Cementless THA with shortening subtrochanteric osteotomy is an effective method in the treatment of patients with Crowe type IV development dysplasia of the hip.
IV.
考虑到患者年龄较轻、髋关节解剖结构异常以及并发症发生率较高，全髋关节置换治疗髋关节高位脱位存在一些困难。在本研究中，我们介绍了采用转子下股骨缩短截骨术和非骨水泥型全髋关节置换术治疗Crowe Ⅳ型髋关节的临床和影像学结果方面的经验。
我们回顾性分析了2000年3月至2006年2月期间接受非骨水泥型全髋关节置换术联合转子下缩短截骨术（9例横截骨术和8例Z形截骨术）治疗的15例Crowe Ⅳ型髋关节发育不良患者（2例双侧病例，共17髋）。平均随访时间为88个月（范围63 - 133个月）。评估标准包括Harris髋关节评分、下肢长度差异、神经状态、截骨愈合情况和假体稳定性。记录所有并发症。
平均Harris髋关节评分从38.3（范围32 - 52）提高到85.6（范围69 - 90）。术前平均下肢长度差异为45 mm（范围38 - 70），术后降至平均12 mm（范围9 - 16）。所有截骨平均在12.3周（范围10 - 15周）愈合。未发现延迟愈合或不愈合病例。2例患者（11%）出现早期坐骨神经麻痹症状，6个月后顺利恢复。无假体移位，无需翻修任何植入物。
非骨水泥型全髋关节置换术联合转子下缩短截骨术是治疗Crowe Ⅳ型髋关节发育不良患者的有效方法。
Ⅳ级。
