THA解剖重建髋臼旋转中心治疗成人DDH
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摘要
[目的]探讨THA解剖重建髋臼旋转中心治疗成人发育性髋关节脱位的临床疗效。[方法]对2010年2月～2018年2月在本院行初次全髋关节置换的102例(118髋) DDH患者进行回顾性分析,其中男37例,女65例;年龄32～71岁,平均(66.35±4.65)岁。依据Crowe分型Ⅰ型60例(65髋),Ⅱ型28例(34髋),Ⅲ型9例(12髋),Ⅳ型5例(7髋)。记录比较各Crowe类型患者围手术期情况、随访和影像资料。[结果]在手术时间、切口大小、术中失血方面随Crowe分型等级增加而增加,Crowe I、Ⅱ型组间比较差异无统计学意义(P>0.05),CroweⅢ、Ⅳ型组间比较差异无统计学意义(P>0.05),但Crowe I、Ⅱ型与CroweⅢ、Ⅳ型组间比较差异有统计学意义(P<0.05)。所有患者切口均一期愈合,无感染。CroweⅡ型组术后出现脱位1例,在全麻下一期行手法复位,余患者未出现脱位等早期并发症。118髋随访2～8年,平均(5.94±2.06)年,随访期间,所有患者未再发生髋关节脱位、骨折等并发症。与术前相比,末次随访各Crowe分型组的VAS评分均显著减少,双侧下肢长度差值均显著减少,Harris评分均显著增加(P<0.05);术前和末次随访时, Harris评分依各Crowe分型等级增加而减少,总体差异均有统计学意义(P<0.05)。至末次随访时,所有患者均无明显疼痛、Trendelenburg征均为阴性。无假体松动、断裂。[结论]成人DDH行初次全髋关节置换在解剖位重建髋关节旋转中心可获得满意临床疗效。
[Objective] To investigate the clinical outcomes of anatomical reconstruction of the rotation center in total hip arthroplasty(THA) for developmental dysplasia of hip(DDH) in adult. [Methods] A retrospective study was conducted on 102 patients(118 hips) who underwent initial THA for DDH in our hospital from February 2010 to February 2018, including 37 males and 65 females with an average age of(66.35±4.65) years ranged from 32 to 71 years. In term of Crowe classification,there were 60 cases(65 hips) in type I, 28 cases(34 hips) in type II, 9 cases(12 hips) in type III and 5 cases(7 hips) in type IV.The perioperative and follow-up data, as well as radiographic parameters were recorded and compared. [Results] The operation time, incision length and intraoperative blood loss increased as upgrading of Crowe classification, with statistically significant differences between the Crowe type I/II groups and Crowe type III/IV groups(P<0.05), despite of no statistically significant differences between Crowe type I and type II group, or Crowe type III and type IV groups(P>0.05). All patients had incision primary healing without infection. Except one patients in the Crowe type II group who got dislocation that was treated by close reduction, all the patients had no serious complications in the early stage after operation. The followed-up period lasted for 2～8 years with an average of(5.94±2.06) years. The VAS score and discrepancy of bilateral lower extremities significantly decreased, while the Harris score significantly increased at the latest follow up compared with those before operation(P<0.05).The Harris score significantly decreased as upgrading of Crowe classification before operation and at the latest follow up(P<0.05). All the patients proved negative Trendelenburg sign, without obvious pain, loosening or fracture of the prosthesis in anyone of them to the latest follow up. [Conclusion] This anatomical reconstruction of the rotation center in THA for DDH in adults does achieve satisfactory clinical results.
[Objective] To investigate the clinical outcomes of anatomical reconstruction of the rotation center in total hip arthroplasty(THA) for developmental dysplasia of hip(DDH) in adult. [Methods] A retrospective study was conducted on 102 patients(118 hips) who underwent initial THA for DDH in our hospital from February 2010 to February 2018, including 37 males and 65 females with an average age of(66.35±4.65) years ranged from 32 to 71 years. In term of Crowe classification,there were 60 cases(65 hips) in type I, 28 cases(34 hips) in type II, 9 cases(12 hips) in type III and 5 cases(7 hips) in type IV.The perioperative and follow-up data, as well as radiographic parameters were recorded and compared. [Results] The operation time, incision length and intraoperative blood loss increased as upgrading of Crowe classification, with statistically significant differences between the Crowe type I/II groups and Crowe type III/IV groups(P<0.05), despite of no statistically significant differences between Crowe type I and type II group, or Crowe type III and type IV groups(P>0.05). All patients had incision primary healing without infection. Except one patients in the Crowe type II group who got dislocation that was treated by close reduction, all the patients had no serious complications in the early stage after operation. The followed-up period lasted for 2～8 years with an average of(5.94±2.06) years. The VAS score and discrepancy of bilateral lower extremities significantly decreased, while the Harris score significantly increased at the latest follow up compared with those before operation(P<0.05).The Harris score significantly decreased as upgrading of Crowe classification before operation and at the latest follow up(P<0.05). All the patients proved negative Trendelenburg sign, without obvious pain, loosening or fracture of the prosthesis in anyone of them to the latest follow up. [Conclusion] This anatomical reconstruction of the rotation center in THA for DDH in adults does achieve satisfactory clinical results.
引文
[1]Mahan ST,Katz JN,Kim YJ.To screen or not to screen.a decision analysis of the utility of screening for developmental dysplasia of the hip[J].J Bone Joint Surg Am,2009,7:1705-1719.
[2]Crowe JF,Mani VJ,Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip[J].J Bone Joint Surg Am,1979,1(1):15-23.
[3]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,4:737-755.
[4]Conn KS,Clarke MT,Hallett JP.A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating[J].J Bone Joint Surg Br,2002,84:269-272.
[5]Engh CA,Suthers KE.The case for porous-coated hip implants.The femoral side[J].Clin Orthop,1990,261(1):63-81.
[6]Suh KT,Kim DW.Comparison of preoperative templating with postoperative assessment in cementless total hip arthroplasty[J].Acta Orthop Scand,2004,75(1):40-44.
[7]Gamble P,Winemaker M.The accuracy of digital templating in uncemented total hip arthroplasty[J].J Arthroplasty,2010,25:529-532.
[8]Multerer C,D?derlein L.Congenital dysplasia and dislocation of the hip:proven and new procedures in diagnostics and therapy[J].Orthopade,2014,43:733-741.
[9]周健生,王志岩,官建中,等.成人髋关节发育不良髋臼解剖学特征及临床意义[J].中华解剖与临床杂志,2014,19(1):2-6.
[10]董建东,王友,朱振安,等.成人髋臼骨计算机三维重建及形态学测量[J].中华外科杂志,2005,24:1583-1586.
[11]Dorr LD,Hishiki Y,Wan Z,et al.Development of imageless computer navigation for acetabular component position in total hip replacement[J].Iowa Orthop J,2005,25:1-9.
[12]Widmer KH.Containment versus impingement:finding a compromise for cup placement in total hip arthroplasty[J].Int Orthop,2007,1:S29-S33.
[13]Wegner A.Fixation method does not affect restoration of rotation center in hip replacements:A single-site retrospective study[J].JOrthop Surg Res,2012,7(1):25.
[14]Hagio K.Primary arthroplasty polyethylene wear associated with26-and 32-mm heads in total hip arthroplasty:a multicenter,prospective study[J].J Arthroplasty,2016,31:2805-2809.
[15]Cinotti G.Do large femoral heads reduce the risks of impingement in total hip arthroplasty with optimal and non-optimal cup positioning[J].Int Orthop,2011,35:317-323.
[16]Garcia-Cimbrelo E.The survival and fate of acetabular reconstruction with impaction grafting for large defects[J].Clin Orthop,2010,468:3304-3313.
[17]Atilla B.Position of the acetabular component determines the fate of emoral head autografts in total hip replacement for acetabular dysplasia[J].J Bone Joint Surg Br,2007,89:874-878.
[18]Harley JM,Wilkinson JA.Hip replacement for adults with unreduced congenital dislocation.A new surgical technique[J].J Bone Joint Surg Br,69:752-755.
[19]Papachristou G,Chronopoulos E.Total hip arthroplasty for developmental hip dysplasia[J].Int Orthop,2006,30(1):21-5.
[20]Ito H,Matsuno T.Hybrid total hip arthroplasty using specificallydesigned stems for patients with developmental dysplasia of the hip.A minimum five-year follow-up study[J].Int Orthop,2011,35:1289-1294.2018-11-07 2019-02-25
[2]Crowe JF,Mani VJ,Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip[J].J Bone Joint Surg Am,1979,1(1):15-23.
[3]Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,4:737-755.
[4]Conn KS,Clarke MT,Hallett JP.A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating[J].J Bone Joint Surg Br,2002,84:269-272.
[5]Engh CA,Suthers KE.The case for porous-coated hip implants.The femoral side[J].Clin Orthop,1990,261(1):63-81.
[6]Suh KT,Kim DW.Comparison of preoperative templating with postoperative assessment in cementless total hip arthroplasty[J].Acta Orthop Scand,2004,75(1):40-44.
[7]Gamble P,Winemaker M.The accuracy of digital templating in uncemented total hip arthroplasty[J].J Arthroplasty,2010,25:529-532.
[8]Multerer C,D?derlein L.Congenital dysplasia and dislocation of the hip:proven and new procedures in diagnostics and therapy[J].Orthopade,2014,43:733-741.
[9]周健生,王志岩,官建中,等.成人髋关节发育不良髋臼解剖学特征及临床意义[J].中华解剖与临床杂志,2014,19(1):2-6.
[10]董建东,王友,朱振安,等.成人髋臼骨计算机三维重建及形态学测量[J].中华外科杂志,2005,24:1583-1586.
[11]Dorr LD,Hishiki Y,Wan Z,et al.Development of imageless computer navigation for acetabular component position in total hip replacement[J].Iowa Orthop J,2005,25:1-9.
[12]Widmer KH.Containment versus impingement:finding a compromise for cup placement in total hip arthroplasty[J].Int Orthop,2007,1:S29-S33.
[13]Wegner A.Fixation method does not affect restoration of rotation center in hip replacements:A single-site retrospective study[J].JOrthop Surg Res,2012,7(1):25.
[14]Hagio K.Primary arthroplasty polyethylene wear associated with26-and 32-mm heads in total hip arthroplasty:a multicenter,prospective study[J].J Arthroplasty,2016,31:2805-2809.
[15]Cinotti G.Do large femoral heads reduce the risks of impingement in total hip arthroplasty with optimal and non-optimal cup positioning[J].Int Orthop,2011,35:317-323.
[16]Garcia-Cimbrelo E.The survival and fate of acetabular reconstruction with impaction grafting for large defects[J].Clin Orthop,2010,468:3304-3313.
[17]Atilla B.Position of the acetabular component determines the fate of emoral head autografts in total hip replacement for acetabular dysplasia[J].J Bone Joint Surg Br,2007,89:874-878.
[18]Harley JM,Wilkinson JA.Hip replacement for adults with unreduced congenital dislocation.A new surgical technique[J].J Bone Joint Surg Br,69:752-755.
[19]Papachristou G,Chronopoulos E.Total hip arthroplasty for developmental hip dysplasia[J].Int Orthop,2006,30(1):21-5.
[20]Ito H,Matsuno T.Hybrid total hip arthroplasty using specificallydesigned stems for patients with developmental dysplasia of the hip.A minimum five-year follow-up study[J].Int Orthop,2011,35:1289-1294.2018-11-07 2019-02-25