采用髋臼结构性植骨的直接前方入路全髋关节置换术治疗发育性髋关节发育不良（Crowe III型和IV型）：5年简要随访评估
Directly anterior approach for total hip arthroplasty with an acetabular structural bone graft for developmental dysplasia of the hip (Crowe III and IV): a concise 5-year follow-up evaluation.
作者信息
Pei Lijia, Liu Ben, Wu Yifan, Wang Yuanhang, Sun Wenhao, Chang Wenju, Zhou Xinshe
机构信息
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Osteoarthritis Diagnosis and Treatment Center in Anhui Province, Laboratory of Tissue and Transplant in Anhui Province, Bengbu Medical University, #287 Zhihuai Road, Bengbu City, Anhui Province, China.
Department of Orthopaedics, Suzhou Hospital Affiliated With Anhui Medical University, #616 BianyangRoad, Suzhou City, Anhui Province, China.
出版信息
BMC Musculoskelet Disord. 2024 Dec 19;25(1):1022. doi: 10.1186/s12891-024-08042-4.
BACKGROUND
This study evaluated the results of total hip arthroplasty (THA) via the direct anterior approach (DAA) in the lateral decubitus position combined with acetabular reconstruction via a bulk autograft for patients with developmental dysplasia of the hip (Crowe III and IV).
PATIENTS AND METHODS
A retrospective study was conducted to analyse 16 patients (16 hips) with Crowe type III and IV developmental dysplasia of the hip (DDH) who underwent THA from June 2016 to July 2021. We recorded and analysed variables such as age, sex, height, body mass index (BMI), length of surgical incision, duration of surgery, intraoperative blood loss, Harris hip score, visual analogue scale (VAS) score, lower limb length, and pelvic radiograph analysis.
RESULTS
The mean age of the patients was 59.3 years, the mean BMI was 22.8 kg/m, and the Crowe classification was type III in 13 hips and type IV in 3 hips. Sixteen patients were followed up with a mean follow-up time of 56.6 (32-92) months. The Harris hip score increased from 48.6 ± 7.5 points preoperatively to 89.6 ± 4.4 points at the final follow-up (t = -18.8, P < 0.001).The VAS score for activity decreased from 7.3 ± 0.8 points preoperatively to 1.0 ± 0.7 points at the final follow-up, which was a statistically significant difference compared with the preoperative score (t = 22.2, P < 0.001). The difference in the length of both lower limbs decreased from 3.0 ± 0.7 cm preoperatively to 0.9 ± 0.4 cm at the final follow-up, and the difference was statistically significant compared with the preoperative difference (t = 10.8, P < 0.001). The acetabular cup coverage was satisfactory.
CONCLUSIONS
Acetabular structural bone grafting THA with lateral decubitus DAA was used to treat Crowe type III and IV DDH with satisfactory efficacy in the medium term, but the learning curve was long. Surgeons need to have extensive clinical experience with DAA to THA.
背景
本研究评估了在侧卧位下采用直接前路（DAA）全髋关节置换术（THA）联合大块自体骨移植进行髋臼重建治疗发育性髋关节发育不良（Crowe III和IV型）患者的效果。
患者与方法
进行一项回顾性研究，分析2016年6月至2021年7月期间接受THA的16例（16髋）Crowe III型和IV型发育性髋关节发育不良（DDH）患者。我们记录并分析了年龄、性别、身高、体重指数（BMI）、手术切口长度、手术时间、术中失血、Harris髋关节评分、视觉模拟量表（VAS）评分、下肢长度以及骨盆X线片分析等变量。
结果
患者的平均年龄为59.3岁，平均BMI为22.8kg/m²，13髋为Crowe III型，3髋为Crowe IV型。16例患者获得随访，平均随访时间为56.6（32 - 92）个月。Harris髋关节评分从术前的48.6±7.5分提高到末次随访时的89.6±4.4分（t = -18.8，P < 0.001）。活动时的VAS评分从术前的7.3±0.8分降至末次随访时的1.0±0.7分，与术前评分相比差异有统计学意义（t = 22.2，P < 0.001）。双下肢长度差异从术前的3.0±0.7cm降至末次随访时的0.9±0.4cm，与术前差异相比差异有统计学意义（t = 10.8，P < 0.001）。髋臼杯覆盖情况良好。
结论
采用侧卧位DAA联合髋臼结构性植骨的THA治疗Crowe III型和IV型DDH，中期疗效满意，但学习曲线较长。外科医生需要有丰富的DAA THA临床经验。
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