Taheriazam Afshin, Poursaleh Erfan, Abbaszadeh Ahmad, Samberani Mehdi, Taheriazam Parsa, Darabi Rezvan, Baghbani Salar
Department of Orthopedics, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran.
BMC Musculoskelet Disord. 2025 Aug 12;26(1):776. doi: 10.1186/s12891-025-09012-0.
Total hip arthroplasty (THA) is a cornerstone intervention for Crowe Type 4 developmental dysplasia of the hip (DDH), a severe form characterized by complete hip dislocation and acetabular deficiency. This study aimed to evaluate the incidence of nerve injury in patients undergoing THA via trochanteric osteotomy and proximal femoral shortening, with a secondary focus on the impact of prosthesis type (cemented vs. cementless).
A prospective cohort study was conducted in Iran on 62 patients (81 hips) with Crowe Type 4 developmental dysplasia of the hip between 2020 and 2022. All procedures utilized a standardized direct lateral approach with trochanteric osteotomy and femoral shortening (3-4 cm). Nerve injury was assessed postoperatively via electromyography/nerve conduction velocity (EMG/NCV). Continuous variables were analyzed using independent t-tests, categorical variables with chi-square tests, and significance set at P < 0.05.
In this study, ultimately, 46 patients (62 hips) completed the study according to the protocol. Among the participants, 54 cases (87.1%) were female and 8 cases (12.9%) were male. The mean age and BMI of patients were 40.35 years and 25.19 Kg/m, respectively. Finally,59 cases (95.2%) were without any neurological deficit and 3 cases (4.8%) developed neurological problem during 12 months after surgery. The frequency of neurological deficit had a statistically significant correlation with the type of prosthesis (P = 0.01).
Trochanteric osteotomy with proximal femoral shortening achieves substantial leg lengthening in Crowe Type 4 developmental dysplasia of the hip, with minimal nerve injury risk. Cementless prostheses demonstrated superior neurological safety, advocating for their preferential use.
全髋关节置换术（THA）是治疗Crowe 4型发育性髋关节发育不良（DDH）的关键干预措施，Crowe 4型是一种严重的髋关节发育不良形式，其特征为髋关节完全脱位和髋臼发育不全。本研究旨在评估通过转子截骨术和股骨近端缩短术进行THA的患者神经损伤的发生率，并次要关注假体类型（骨水泥型与非骨水泥型）的影响。
2020年至2022年期间，在伊朗对62例（81髋）Crowe 4型发育性髋关节发育不良患者进行了一项前瞻性队列研究。所有手术均采用标准化的直接外侧入路，进行转子截骨术和股骨缩短（3-4厘米）。术后通过肌电图/神经传导速度（EMG/NCV）评估神经损伤情况。连续变量采用独立t检验进行分析，分类变量采用卡方检验进行分析，显著性水平设定为P < 0.05。
在本研究中，最终有46例（62髋）患者按照方案完成了研究。参与者中，女性54例（87.1%），男性8例（12.9%）。患者的平均年龄和体重指数分别为40.35岁和25.19 Kg/m²。最后，59例（95.2%）患者在术后12个月内无任何神经功能缺损，3例（4.8%）出现神经问题。神经功能缺损的发生率与假体类型具有统计学显著相关性（P = 0.01）。
转子截骨术联合股骨近端缩短术在Crowe 4型发育性髋关节发育不良中可实现显著的肢体延长，且神经损伤风险最小。非骨水泥型假体显示出更好的神经安全性，建议优先使用。
