人工全髖關節置換術治療成人Crowe Ⅳ型先天性髖關節發育不良伴脫位_《中國修復重建外科雜志》

作者：

李文波 , 張文明 , 白國昌 , 黃子達 , 沈榮凱

福建醫科大學附屬第一醫院骨科（福州，350001）;

關鍵詞：

先天性髖關節發育不良髖關節脫位人工全髖關節置換術

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目的探討人工全髖關節置換術（total hip arthroplasty，THA）治療成人Crowe Ⅳ型先天性髖關節發育不良伴脫位的髖臼假體選擇及療效。方法2008年6月－2012年5月，收治8例8髖Crowe Ⅳ型先天性髖關節發育不良伴脫位女性患者；年齡20～35歲，平均25歲。左髖5例，右髖3例。患髖Harris評分為（53.9 ± 6.6）分。患肢較健側短縮4～6 cm，平均4.8 cm。X線片示患髖均完全高位脫位。術中采用42～44 mm小號髖臼假體、S-ROM股骨假體并轉子下截骨行THA。結果患者切口均Ⅰ期愈合，無髖關節脫位、坐骨神經損傷發生。術后2 d 1例發生股神經損傷，術后7 d 2例出現無癥狀下肢肌間靜脈血栓形成，均經對癥處理后治愈。8例均獲隨訪，隨訪時間1～5年，平均3年。患者術前跛行步態均明顯改善，均恢復日常工作。術后6個月測量患肢長度與健側相差—1.0～0.6 cm，平均0.4 cm。髖關節Harris評分達（87.6 ± 0.3）分，與術前比較差異有統計學意義（t=1.77，P=0.00）。X線片復查示，股骨截骨處均在術后3～6 個月愈合；髖臼假體-骨界面穩固，無松動。隨訪期間無假體翻修。結論使用小號髖臼假體并轉子下截骨行THA是治療成人Crowe Ⅳ型先天性髖關節發育不良伴脫位的有效方法之一，近期療效較滿意，但假體遠期生存率仍需進一步觀察。

引用本文： 李文波,張文明,白國昌,黃子達,沈榮凱. 人工全髖關節置換術治療成人Crowe Ⅳ型先天性髖關節發育不良伴脫位. 中國修復重建外科雜志, 2013, 27(10): 1153-1156. doi: 復制

1.	Gee MJ, Ajuied A, Shah Z, et al. Systematic review of total hip arthroplasty in patients under 30 years old. Hip Int, 2013. [Epub ahead of print].
2.	Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
3.	Cameron HU, Botsford DJ, Park YS. Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty, 1996, 11(5): 582-587.
4.	Noble PC, Kamaric E, Sugano N, et al. Three-dimentional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, (417): 27-40.
5.	Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): s1033-1036.
6.	Bruce WJ, Rizkallall SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
7.	Dapuzzo MR, Sierra RJ. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am, 2012, 43(3): 369-375.
8.	Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444.
9.	Rozkydal Z, Smid Z, Kristek J. Structural bone grafting in THR with cup for dysplastic hip. Acta Chir Orthop Traumatol Cech, 2000, 67(5): 298-306.
10.	Somferd MP, Bolder SB, Gardeniers JW, et al. Favorable survival of acetabular reconstruction with bone impaction grafting in dysplastic hips. Clin Orthop Relat Res, 2008, 466(2): 359-365.
11.	Linde F, Jermen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res, 1988, (227): 164-171.
12.	康鵬德, 楊靜, 沈彬, 等. CroweⅣ型髖關節發育不良全髖關節置換術前計算機輔助設計. 中華骨科雜志, 2012, 32(5): 442-446.
13.	Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801.
14.	Bartz RL, Nobel PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307.
15.	趙德偉, 劉宇鵬, 崔旭. 大齡中、高位先天性髖脫位全髖置換術方法探討. 中國骨與關節損傷雜志, 2006, 21(5): 350-352.
16.	Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141.
17.	Willis-Owen CA, Nishiwaki T, Spriggins AJ. Sciatic palsy after total hip arthroplasty associated with vascular graft occlusion. Hip Int, 2011, 21(1): 118-121.
18.	Neumann D, Thaler C, Dorn U. Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip. Int Orthop, 2012, 36(3): 499-503.

1. Gee MJ, Ajuied A, Shah Z, et al. Systematic review of total hip arthroplasty in patients under 30 years old. Hip Int, 2013. [Epub ahead of print].
2. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg (Am), 1979, 61(1): 15-23.
3. Cameron HU, Botsford DJ, Park YS. Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty, 1996, 11(5): 582-587.
4. Noble PC, Kamaric E, Sugano N, et al. Three-dimentional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res, 2003, (417): 27-40.
5. Christie M, Brinson MF. Proximal/distal mismatch: type A and C femurs. Orthopedics, 2005, 28(9 Suppl): s1033-1036.
6. Bruce WJ, Rizkallall SM, Kwon YM, et al. A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases. J Arthroplasty, 2000, 15(5): 617-626.
7. Dapuzzo MR, Sierra RJ. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am, 2012, 43(3): 369-375.
8. Tsukada S, Wakui M. Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty, 2012, 27(3): 437-444.
9. Rozkydal Z, Smid Z, Kristek J. Structural bone grafting in THR with cup for dysplastic hip. Acta Chir Orthop Traumatol Cech, 2000, 67(5): 298-306.
10. Somferd MP, Bolder SB, Gardeniers JW, et al. Favorable survival of acetabular reconstruction with bone impaction grafting in dysplastic hips. Clin Orthop Relat Res, 2008, 466(2): 359-365.
11. Linde F, Jermen J, Pilgaard S. Charnley arthroplasty in osteoarthritis secondary to congenital dislocation or subluxation of the hip. Clin Orthop Relat Res, 1988, (227): 164-171.
12. 康鵬德, 楊靜, 沈彬, 等. CroweⅣ型髖關節發育不良全髖關節置換術前計算機輔助設計. 中華骨科雜志, 2012, 32(5): 442-446.
13. Wu X, Li SH, Lou LM, et al. The techniques of soft tissue release and true socket reconstruction in total hip arthroplasty for patients with severe developmental dysplasia of the hip. Int Orthop, 2012, 36(9): 1795-1801.
14. Bartz RL, Nobel PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307.
15. 趙德偉, 劉宇鵬, 崔旭. 大齡中、高位先天性髖脫位全髖置換術方法探討. 中國骨與關節損傷雜志, 2006, 21(5): 350-352.
16. Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res, 1987, (218): 136-141.
17. Willis-Owen CA, Nishiwaki T, Spriggins AJ. Sciatic palsy after total hip arthroplasty associated with vascular graft occlusion. Hip Int, 2011, 21(1): 118-121.
18. Neumann D, Thaler C, Dorn U. Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip. Int Orthop, 2012, 36(3): 499-503.

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