Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.
J Orthop Surg Res. 2020 Nov 26;15(1):561. doi: 10.1186/s13018-020-02088-5.
Many methods have been proposed to increase cup coverage by host bone during primary total hip arthroplasty (THA) in hip osteoarthritis secondary to developmental dysplasia of the hip (DDH). However, there was no study comparing the results of controlled fracture of the medial wall with a structural autograft with a bulk femoral head.
Sixty-seven hips classified as Crowe II/III were retrospectively included in this cohort study, which consisted of 33 controlled fractures (group A) and 34 structural autografts (group B). The Harris Hip Scores (HHS) were recorded. The radiological assessments were analyzed. Also, complications are assessed. The paired-sample t test was used for data analysis before and after the operation, while the independent sample T test was used for the comparison between the two groups. The Pearson chi-square test or the Fisher exact test was used to analyze the qualitative comparative parameters. Kaplan-Meier was utilized in the analysis of survivorship with the end points as a revision for any component.
All patients were reconstructed acetabulum at the anatomical location. HHS increased greatly for both groups (p = 0.18). No statistic difference was observed for the two groups in postoperative leg-length discrepancy (0.51 ± 0.29 cm for group A and 0.46 ± 0.39 cm for group B, p = 0.64 ), postoperative height of the hip center (2.25 ± 0.42 cm for group A and 2.09 ± 0.31 cm for group B, p = 0.13), and inclination of the cup (39 ± 4° for group A and 38 ± 3° for group B, p = 0.65 ). The rate of cup coverage for group B (94 ± 2%) was better than for group A (91 ± 5%), (p = .009). The rate of cup protrusio was 48 ± 4% for group A. For both groups, no statistical difference was observed in the cup diameter (p > .05), while group A showed less operation time than group B (p < .001). No complications were observed at the latest follow-up.
Controlled fracture of the medial wall to increase cup coverage by host bone at the anatomical location can act as an alternative technique for DDH Crowe II/III with the advantage of shorter operation time and less technically demanding.
在髋关节发育不良（DDH）继发的髋骨关节炎患者初次全髋关节置换术（THA）中，为增加杯覆盖宿主骨，已经提出了许多方法。然而，尚无研究比较内侧壁控制性骨折与结构性自体移植物与大块股骨头的结果。
本回顾性队列研究纳入了 67 髋，分为 33 例控制性骨折（A 组）和 34 例结构性自体移植物（B 组）。记录 Harris 髋关节评分（HHS）。分析影像学评估。还评估了并发症。手术前后采用配对样本 t 检验进行数据分析，两组间比较采用独立样本 t 检验。采用 Pearson 卡方检验或 Fisher 确切概率法分析定性比较参数。采用 Kaplan-Meier 分析以任何组件的翻修为终点的生存率。
所有患者髋臼均在解剖位置重建。两组 HHS 均显著增加（p = 0.18）。两组术后下肢长度差异（A 组 0.51 ± 0.29 cm，B 组 0.46 ± 0.39 cm，p = 0.64）、术后髋关节中心高度（A 组 2.25 ± 0.42 cm，B 组 2.09 ± 0.31 cm，p = 0.13）和杯倾斜度（A 组 39 ± 4°，B 组 38 ± 3°，p = 0.65）无统计学差异。B 组（94 ± 2%）的杯覆盖率优于 A 组（91 ± 5%）（p = 0.009）。A 组杯突出率为 48 ± 4%。对于两组，杯直径无统计学差异（p >.05），而 A 组的手术时间短于 B 组（p <.001）。末次随访时未见并发症。
在髋臼解剖位置增加宿主骨杯覆盖的内侧壁控制性骨折可作为 DDH Crowe II/III 的替代技术，其优势在于手术时间更短，技术要求更低。
