Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, No.415, Fengyang Road, Huangpu District, Shanghai, 200003, China.
J Orthop Surg Res. 2024 Jan 3;19(1):12. doi: 10.1186/s13018-023-04344-w.
The choice of osteotomy in joint replacement surgery for Crowe type IV developmental dysplasia of the hip (DDH) is a challenging and controversial procedure. In this study, we compared the clinical efficacy of a combination of greater trochanter osteotomy and tension wire fixation with that of subtrochanteric osteotomy.
We performed 15 primary total hip arthroplasty (THA) procedures between January 2016 and July 2020 on 13 patients with a combination of greater trochanter osteotomy and tension wire fixation (the GTT group) and 12 THA procedures in 11 patients using subtrochanteric osteotomy (the STO group). The mean follow-up was 2.8 years (range 2.2-4.5 years) in the GTT group and 2.6 years (range 2.5-4.3 years) in the STO group. Clinical scores and radiographic results were evaluated during the final follow-up for the 15 hips in the GTT group and 12 hips in the STO group.
Postoperative Harris hip scores, implant position, and the surgery time did not differ between the treatment groups. There were no differences in preoperative leg length discrepancy LLD (P = 0.46) and postoperative LLD (P = 0.56) between the two groups. Bone union occurred within 6 months after surgery in 12 hips in the GTT group (92.3%) and in 9 hips (81.8%) in the STO group. One case in the GTT group and two cases in the STO group had nonunion, and additionally, there was one case of postoperative nerve injury in the STO group, while no symptoms of nerve damage were observed in the GTT group.
The GTT method demonstrated many advantages and reliable clinical results for Crowe type IV DDH patients undergoing THA. This is a surgical method that warrants further development and promotion clinically.
在髋关节发育不良（DDH）克罗魏四型关节置换手术中，选择截骨术是一项具有挑战性和争议性的手术。本研究比较了大转子截骨加张力带固定与转子下截骨术的临床疗效。
2016 年 1 月至 2020 年 7 月，我们对 13 例（GTT 组）采用大转子截骨加张力带固定和 11 例（STO 组）采用转子下截骨术的 15 例初次全髋关节置换术（THA）患者进行了手术。GTT 组的平均随访时间为 2.8 年（2.2-4.5 年），STO 组为 2.6 年（2.5-4.3 年）。对 GTT 组的 15 髋和 STO 组的 12 髋进行了最终随访的临床评分和影像学结果评估。
两组治疗后 Harris 髋关节评分、假体位置和手术时间无差异。两组术前下肢长度差异（P=0.46）和术后下肢长度差异（P=0.56）无差异。GTT 组 12 髋（92.3%）和 STO 组 9 髋（81.8%）术后 6 个月内均发生骨愈合。GTT 组 1 例和 STO 组 2 例发生骨不连，另外 STO 组 1 例术后发生神经损伤，而 GTT 组无神经损伤症状。
GTT 方法为接受 THA 的克罗魏四型 DDH 患者提供了许多优势和可靠的临床结果。这是一种值得进一步发展和推广的手术方法。
