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直接前入路全髋关节置换术治疗严重发育不良（Crowe III 和 IV 型）可获得满意的中远期疗效。

The Direct Anterior Approach for Total Hip Arthroplasty for Severe Dysplasia (Crowe III and IV) Provides Satisfactory Medium to Long-Term Outcomes.

机构信息

Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France; Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, Brazil.

Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

出版信息

J Arthroplasty. 2020 Jun;35(6):1642-1650. doi: 10.1016/j.arth.2020.01.022. Epub 2020 Jan 17.

DOI:10.1016/j.arth.2020.01.022

PMID:32046871

Abstract

BACKGROUND

The direct anterior approach (DAA) is increasingly used for total hip arthroplasty (THA). Although the DAA can reduce pain, recovery time, and dislocations in nondysplastic hips, few studies report its results in patients with severe dysplasia. We aimed to evaluate outcomes of primary THA through the DAA with cup placement at the true acetabulum in hips with severe dysplasia.

METHODS

We retrospectively evaluated 23 consecutive patients (29 hips) who underwent THA by DAA for osteoarthritis secondary to Crowe III-IV dysplasia. Surgical procedures were performed on a traction table, and the acetabular cup was placed in the true acetabulum. Patients were assessed clinically (complications, modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Hip Score) and radiographically (radiolucencies, subsidence, leg length discrepancies, cup inclination, and cup coverage) at a minimum of 2 years.

RESULTS

One patient (2 hips) died with original implants (at 13 and 14 years), 3 patients (3 hips) were revised due to wear-induced loosening (at 14, 16, and 18 years), and there were no dislocations or infections. The remaining 19 patients (24 hips) were assessed at 8.4 ± 4.7 years (range 2-20); 2 patients (2 hips) had complications that required reoperation without implant removal. The modified Harris Hip Score improved from 32 ± 9 to 94 ± 7, Western Ontario and McMaster Universities Osteoarthritis Index from 46 ± 18 to 90 ± 7, and Oxford Hip Score was 56 ± 4. Patients were very satisfied (90%) or satisfied (10%). Limb length discrepancy was 2.5 ± 9.0 mm.

CONCLUSION

THA through the DAA with cup placement at the true acetabulum provides satisfactory mid to long-term clinical and radiographic outcomes compared to other approaches for hips with severe dysplasia.

LEVEL OF EVIDENCE

Level IV, retrospective cohort study.

摘要

背景

直接前方入路（DAA）越来越多地用于全髋关节置换术（THA）。虽然 DAA 可以减少非发育性髋关节的疼痛、恢复时间和脱位，但很少有研究报告其在严重发育不良患者中的结果。我们旨在评估通过 DAA 在严重发育不良的髋关节中在真髋臼处放置髋臼杯进行初次 THA 的结果。

方法

我们回顾性评估了 23 例连续患者（29 髋），这些患者因 Crowe III-IV 型发育不良继发骨关节炎而行 DAA 行 THA。手术在牵引台上进行，髋臼杯放置在真髋臼中。患者至少在 2 年后进行临床评估（并发症、改良 Harris 髋关节评分、西安大略和麦克马斯特大学骨关节炎指数、牛津髋关节评分）和影像学评估（透亮线、下沉、肢体长度差异、杯倾斜和杯覆盖）。

结果

1 例患者（2 髋）死亡，植入物未取出（分别为 13 年和 14 年），3 例患者（3 髋）因磨损导致松动而翻修（分别为 14 年、16 年和 18 年），无脱位或感染。其余 19 例患者（24 髋）在 8.4 ± 4.7 年（范围 2-20）时进行了评估；2 例患者（2 髋）因并发症需要再次手术，但未取出植入物。改良 Harris 髋关节评分从 32 ± 9 提高到 94 ± 7，西安大略和麦克马斯特大学骨关节炎指数从 46 ± 18 提高到 90 ± 7，牛津髋关节评分是 56 ± 4。患者非常满意（90%）或满意（10%）。肢体长度差异为 2.5 ± 9.0 毫米。