Coşkun Mehmet, Aydin Abdurrahman, Akbulut Deniz
Van Akdamar Hospital, Van, Turkey.
Düzce Akcakoca State Hospital, Düzce, Turkey.
Medicine (Baltimore). 2025 Jun 13;104(24):e42784. doi: 10.1097/MD.0000000000042784.
In hip arthroplasties performed on patients with Crowe type 4 dysplasia, femoral shortening is often required to position the hip into the true acetabulum. Nonunion at the osteotomy site is one of the significant comorbidities in osteotomies that lower the hip into the true acetabulum. This study aimed to evaluate the clinical and radiological outcomes of hip arthroplasty with femoral shortening in patients with Crowe type 4 dysplasia using the technique we developed. This study retrospectively evaluated the outcomes of 96 (117 hips) patients who underwent subtrochanteric transverse shortening osteotomy due to Crowe type 4 dysplasia between January 2016 and December 2020, with a minimum follow-up period of 24 months. Harris Hip Score (HHS) was used for clinical evaluation of the patients, followed by comparison of preoperative and postoperative values. Radiological evaluation included assessments of union time, leg length discrepancy, and union rates. Intraoperative and postoperative complications were noted. The HHS had a mean preoperative value of 54.66 ± 7.47 and increased significantly postoperatively to a mean value of 93.82 ± 7.00 (P < .05). Changes in HHS (~39.2) surpass the minimal clinically important difference threshold. At the final follow-up, the union was observed in 115 (98.3%) hips. Despite a follow-up period exceeding 24 months, nonunion was radiologically observed in 2 (1.7%) hips. Our observations had relatively lower rates than those reported in literature. The preoperative and postoperative leg length discrepancies were measured as 5.03 ± 1.09 cm and 0.64 ± 0.74 cm, respectively (P < .05). Intraoperatively, femoral fractures were observed in 12 (10.3%) hips, dislocations in 5 (4.3%) hips, and sciatic nerve injury in 4 (3.4%) hips. In hip arthroplasties performed on patients with Crowe type 4 dysplasia, supporting the strut graft around the subtrochanteric transverse osteotomy site with cancellous bone taken from the trochanter major and femoral head reduces the risk of nonunion, and satisfactory clinical outcomes can be achieved with this method.
在为Crowe 4型发育不良患者进行的髋关节置换术中，通常需要缩短股骨以将髋关节置于真髋臼内。截骨部位不愈合是将髋关节降低至真髋臼的截骨术中的重要合并症之一。本研究旨在使用我们开发的技术评估Crowe 4型发育不良患者行股骨缩短髋关节置换术的临床和影像学结果。本研究回顾性评估了2016年1月至2020年12月期间因Crowe 4型发育不良接受转子下横向缩短截骨术的96例（117髋）患者的结果，最短随访期为24个月。采用Harris髋关节评分（HHS）对患者进行临床评估，然后比较术前和术后的值。影像学评估包括对愈合时间、肢体长度差异和愈合率的评估。记录术中及术后并发症。HHS术前平均值为54.66±7.47，术后显著增加至平均值93.82±7.00（P<0.05）。HHS的变化（约39.2）超过了最小临床重要差异阈值。在最后随访时，115髋（98.3%）观察到愈合。尽管随访期超过24个月，但影像学观察到2髋（1.7%）不愈合。我们观察到的发生率比文献报道的相对较低。术前和术后肢体长度差异分别测量为5.03±1.09cm和0.64±0.74cm（P<0.05）。术中，12髋（10.3%）观察到股骨骨折，5髋（4.3%）观察到脱位，4髋（3.4%）观察到坐骨神经损伤。在为Crowe 4型发育不良患者进行的髋关节置换术中，用取自大转子和股骨头的松质骨支撑转子下横向截骨部位周围的支撑骨移植可降低不愈合风险，采用该方法可获得满意的临床结果。
