Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
Turk J Med Sci. 2021 Aug 30;51(4):1976-1983. doi: 10.3906/sag-2102-217.
BACKGROUND/AIM: Total hip arthroplasty (THA) is technically more difficult and has higher complication rates in patients with Crowe type 3–4 developmental dysplasia of the hip (DDH). Due to the difficulties and different treatment options, there is still no consensus on the optimal treatment. We aimed to evaluate the mid-term results of our patients who had undergone subtrochanteric femoral shortening Z-osteotomy.
This study included 37 hips of 29 patients with the diagnosis of Crowe 3-4 DDH between June 2010 and December 2016 and who underwent femoral shortening Z-osteotomy with cementless total hip arthroplasty. Acetabular component was determined according to the patient’s age and functional capacity and all patients were operated with a posterior approach. Functional results, postoperative complications, Harris and visual analogue scale (VAS) scores were evaluated.
The average Harris hip score was 41.3 ± 3.1 preoperatively and 84.7 ± 4.3 postoperatively (p < 0.05). The mean preoperative hip pain score on the VAS was 7.9 (range: 6–9) and this was significantly lower at the last follow-up (mean: 3.4; range: 2–4) (p < 0.05). The final mean limb-length discrepancy was 1.3 cm. The average amount of femoral shortening was 3.2 cm. Regarding complications, 3 (10.3%) patients had dislocations. These patients underwent closed reduction. Sciatic palsy developed in 1 (3.4%) patient. The patient was reoperated on for sciatic nerve dissection in the early period.
Subtrochanteric shortening Z-osteotomy combined with cementless total hip replacement can be considered an effective and successful method in selected patients with Crowe 3-4 coxarthrosis.
背景/目的：全髋关节置换术（THA）在 Crowe 3-4 型发育性髋关节发育不良（DDH）患者中技术难度更大，并发症发生率更高。由于难度和不同的治疗选择，对于最佳治疗方法仍未达成共识。我们旨在评估接受股骨转子下缩短 Z 截骨术的患者的中期结果。
这项研究纳入了 2010 年 6 月至 2016 年 12 月期间诊断为 Crowe 3-4 DDH 的 29 名患者的 37 髋，并接受了股骨缩短 Z 截骨术联合非骨水泥全髋关节置换术。髋臼组件根据患者的年龄和功能能力确定，所有患者均采用后入路进行手术。评估了功能结果、术后并发症、Harris 和视觉模拟量表（VAS）评分。
术前平均 Harris 髋关节评分为 41.3±3.1，术后为 84.7±4.3（p<0.05）。术前 VAS 髋关节疼痛评分平均为 7.9（范围：6-9），末次随访时明显降低（平均：3.4；范围：2-4）（p<0.05）。最终平均肢体长度差异为 1.3cm。股骨缩短的平均长度为 3.2cm。关于并发症，3（10.3%）例患者发生脱位。这些患者接受了闭合复位。1（3.4%）例患者发生坐骨神经麻痹。该患者在早期接受了坐骨神经松解术的再次手术。
在选择的 Crowe 3-4 髋关节炎患者中，股骨转子下缩短 Z 截骨术联合非骨水泥全髋关节置换术可被视为一种有效且成功的方法。
