Necas Libor, Hrubina Maros, Melisik Marian, Cibula Zoltan, Chmurny Michal, Daniel Matej, Steno Boris
Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
University Department of Orthopaedic Surgery, University Hospital Martin, Kollarova 2, 036 59, Martin, Slovak Republic.
Eur J Orthop Surg Traumatol. 2019 Jul;29(5):1025-1033. doi: 10.1007/s00590-019-02400-y. Epub 2019 Feb 13.
The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem.
We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018.
The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5 cm preoperatively to 1.4 cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8 months.
Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.
本研究的目的是介绍采用横断转子下缩短截骨术并使用S-ROM柄进行非骨水泥型髋关节置换术治疗发育性髋关节发育不良Crowe IV型的结果。
我们评估了连续23例（28髋）髋关节高位脱位患者的X线片、功能评分及并发症情况。患者手术时的平均年龄为49.9岁（范围22 - 68岁）。手术于2007年至2013年期间进行。在2018年对患者进行了回顾性临床和影像学评估。
平均随访期为94个月（范围60 - 134个月）。Harris髋关节平均评分从39.9分提高到84.0分。平均肢体长度差异从术前的5厘米降至末次随访时的1.4厘米。所有髋臼假体均植入真髋臼，且在最近一次检查时所有假体均稳定。未记录到神经血管损伤。我们总共在7髋（25%）中发现了特定并发症：4髋术中发生股骨骨折需要固定；3髋（10.7%）需要翻修：2髋发生复发性脱位，需要重新调整髋臼杯方向（其中1髋随后需要切除异位骨化）；1髋发生无菌性柄松动，需要一期翻修。所有截骨均在8个月内愈合。
采用S-ROM柄进行股骨横断缩短截骨术的髋关节置换术，对于Crowe IV型发育性髋关节发育不良患者来说，在中期是一种可接受但并非无并发症的治疗方法。
