转子下截骨全髋关节置换治疗Crowe 郁型 髋关节发育不良的围手术期并发症

徐海军 周一新 唐杞衡 刘庆 殷建华 郭晓忠 李为 徐辉 李玉军作者单位院100035 北京积水潭医院矫形骨科 通信作者院周一新orthoyixin@yahoo.com临床论著揖摘要铱 目的 分析转子下截骨全髋关节置换治疗Crowe郁型髋关节发育不良的围手术期并发 症遥方法 20

正文

徐海军 周一新 唐杞衡 刘庆 殷建华 郭晓忠 李为 徐辉 李玉军

作者单位院100035 北京积水潭医院矫形骨科 通信作者院周一新orthoyixin@yahoo.com

临床论著

揖摘要铱 目的 分析转子下截骨全髋关节置换治疗Crowe郁型髋关节发育不良的围手术期并发 症遥方法 2002年6月至2009年8月袁因Crowe郁型髋关节发育不良接受股骨转子下截骨全髋关节置 换术 35 例 42 髋袁男 11 例袁女 24 例曰年龄 28~68 岁袁平均渊47.4依9.61冤岁遥 回顾性分析围手术期并发症的 类型尧发生率及导致并发症的相关因素遥结果 全部病例随访3~84个月袁平均24.3个月遥术前Harris评 分平均渊60.42依14.41冤分袁末次随访平均渊81.58依26.96冤分袁差异有统计学意义渊t=-2.3545袁P=0.0382冤遥 共 18 髋发生并发症 21 髋次袁并发症发生率 42.9%渊18/42冤曰其中 20 髋次出现于 2008 年以前的病例袁并发 症发生率 65.4%渊17/26冤遥 包括骨折 11 髋渊26.2%冤袁血管并发症 2 髋渊4.8%冤袁神经并发症 4 髋渊9.5%冤袁截 骨不愈合 2 髋渊4.8%冤袁术后脱位及假体松动各 1 髋渊2.4%冤遥 行预防性钢丝环扎的 10 髋均未出现骨折袁 未行预防性环扎 32 髋中 11 髋出现骨折袁两组差异有统计学意义渊字2=4.657袁P=0.031冤遥 Hartofilakidis C1 型髋关节发育不良患者围手术期并发症发生率为 55.0%渊11/20冤袁C2 型为 23.1%渊3/13冤袁 差异无统计学 意义渊字2=3.287袁P=0.070冤遥结论 对Crowe郁型髋关节发育不良行转子下截骨全髋关节置换并发症发 生率高遥 周密的术前设计和规范的手术操作可减少围手术期并发症的发生遥

揖关键词铱 关节成形术袁置换袁髋曰髋脱位袁先天性;骨关节炎袁髋;截骨术 揖证据等级铱 治疗性研究郁级

Total hip arthroplasty with shortening subtrochanteric osteotomy for severe developmental dysplasia ofthehip XUHai鄄jun,ZHOUYi鄄xin,TANGQi鄄heng,etal.DepartmentofOrthopaedicSurgery,Beijing Jishuitan Hospital, Beijing 100035, China

揖Abstract铱 Objective To evaluate the complications of total hip arthroplasty (THA) with a shortening subtrochanteric osteotomy in a group of patients with Crowe type 郁 developmental dysplasia of thehip (DDH),andtorefinesurgicaltechniquestodecreasetheincidenceofthecomplications.Methods From Jun. 2002 to Aug. 2009, 35 patients (42 hips) with Crowe type 郁 DDH underwent DDH, including 24 females and 11 males, with the mean age of 渊47.4依9.61冤 years. The results and complications were evaluated retrospectively. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. Results The mean Harris hip score increased from 60.42依14.41 points preoperatively to 81.58依26.96 points at the time of final follow鄄up (P=0.0382). Eighteen of the 42 hips (42.9%) had a peri鄄operative complication. Eleven perioperative fractures happened. Two hips were followed by nonunion. Four nerve injuries and two vascular injuries occurred. One hip dislocated postoperatively. All components were well鄄fixed at the time of the last radiographic follow鄄up except one femur stem loosened. Avoidance of over or under reaming, appropriating osteotomy level and prophylactic cerclage wiring were associated with low complication rate. Conclusion Subtrochanteric osteotomy, performed in THA for osteoarthritis secondary to Crowe type 郁 DDH, is a highly complicated surgical procedure. Appropriate prosthesis selection and meticulous surgical techniques is mandatory and efficient to decrease the complication rates.

揖Keywords铱 Arthroplasty,replacement,hip;Hipdislocation,congenital;Osteoarthritis,hip;Osteotomy

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