Liu Yuchen, Wang Fuyang, Ying Jiawei, Cheng Liangliang, Zhao Dewei
Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Mar 15;37(3):353-359. doi: 10.7507/1002-1892.202211052.
To summarize the characteristics and biomechanical research progress of common acetabular reconstruction techniques in patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA), and provide references for selecting appropriate acetabular reconstruction techniques for clinical treatment of Crowe type Ⅱ and Ⅲ DDH.
The domestic and foreign relevant literature on biomechanics of acetabular reconstruction with Crowe type Ⅱ and Ⅲ DDH was reviewed, and the research progress was summarized.
At present, there are many acetabular reconstruction techniques in Crowe type Ⅱ and Ⅲ DDH patients undergoing THA, with their own characteristics due to structural and biomechanical differences. The acetabular roof reconstruction technique enables the acetabular cup prosthesis to obtain satisfactory initial stability, increases the acetabular bone reserve, and provides a bone mass basis for the possible secondary revision. The medial protrusio technique (MPT) reduces the stress in the weight-bearing area of the hip joint and the wear of the prosthesis, and increases the service life of the prosthesis. Small acetabulum cup technique enables shallow small acetabulum to match suitable acetabulum cup to obtain ideal cup coverage, but small acetabulum cup also increases the stress per unit area of acetabulum cup, which is not conducive to the long-term effectiveness. The rotation center up-shifting technique increases the initial stability of the cup.
Currently, there is no detailed standard guidance for the selection of acetabular reconstruction in THA with Crowe type Ⅱ and Ⅲ DDH, and the appropriate acetabular reconstruction technique should be selected according to the different types of DDH.
总结全髋关节置换术(THA)治疗CroweⅡ型和Ⅲ型发育性髋关节发育不良(DDH)患者时常见髋臼重建技术的特点及生物力学研究进展,为临床治疗CroweⅡ型和Ⅲ型DDH选择合适的髋臼重建技术提供参考。
回顾国内外关于CroweⅡ型和Ⅲ型DDH髋臼重建生物力学的相关文献,总结研究进展。
目前,THA治疗CroweⅡ型和Ⅲ型DDH患者的髋臼重建技术较多,因结构和生物力学差异各有特点。髋臼顶重建技术能使髋臼杯假体获得满意的初始稳定性,增加髋臼骨储备,为可能的二次翻修提供骨量基础。髋臼内移技术(MPT)降低了髋关节负重区应力和假体磨损,增加了假体使用寿命。小髋臼杯技术能使浅小髋臼匹配合适的髋臼杯以获得理想的髋臼覆盖,但小髋臼杯也增加了髋臼杯单位面积应力,不利于长期疗效。旋转中心上移技术增加了髋臼杯的初始稳定性。
目前,对于CroweⅡ型和Ⅲ型DDH的THA髋臼重建选择尚无详细的标准指导,应根据不同类型的DDH选择合适的髋臼重建技术。