Becker V形外旋截骨在CroweⅣ型發育性髖關節脫位人工全髖關節置換術中的應用_《中國修復重建外科雜志》

作者：

1保定市第一中心醫院骨三科（河北保定，071000）;;
2蘇州大學附屬第一醫院骨科;

關鍵詞：

發育性髖關節脫位股骨前傾角截骨術人工全髖關節置換術

DOI：

10.7507/1002-1892.20130225

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目的總結在CroweⅣ型發育性髖關節脫位（development dislocation of the hip，DDH）人工全髖關節置換術（total hip arthroplasty，THA）中采用Becker V形外旋截骨矯正股骨異常前傾的方法與療效。方法2000年1月－2009年12月，收治18例22髖CroweⅣ型DDH患者。其中男3例，女15例；年齡41～75歲，平均54歲。單髖14例，雙髖4例。重度跛行13例，中度5例。均為股骨異常前傾，術前髖臼前傾角為（21.28 ± 4.87）°，股骨前傾角為（59.06 ± 1.44）°，聯合前傾角為（80.33 ± 1.55）°。18例雙下肢均不等長，相差1.0～3.5 cm，平均2.5 cm。術前臀中肌肌力2級17髖，3級5髖。Trendelenburg征均為陽性。術前Harris評分為（30.00 ± 6.32）分。采用Becker V形外旋截骨加股骨轉子下疊加短縮截骨，生物型假體置換治療，其中21髖股骨髓腔狹窄畸形者加行股骨近端縱向劈開成形術。結果術后切口均Ⅰ期愈合；無切口感染、前脫位、下肢神經牽拉傷及失控性骨折等并發癥發生。18例均獲隨訪，隨訪時間3～12年，平均8年。股骨假體術后初始固定質量獲優18髖，良4髖。術后3～6個月，平均5個月截骨斷端均獲骨性愈合。術后1年測量患肢延長2.5～3.5 cm，平均3.0 cm；雙下肢相差0.5～1.5 cm，平均1.0 cm。術后1年患者臀中肌肌力恢復至4級5髖、5級17髖。末次隨訪時，患者步態正常13例、輕度跛行5例，Trendelenburg征陰性15例、陽性3例，Harris評分為（91.89 ± 3.22）分，與術前比較差異均有統計學意義（P lt; 0.05）。末次隨訪時患者髖臼、股骨假體前傾角及聯合前傾角分別為（19.33 ± 4.49）、（13.33 ± 5.70）、（32.67 ± 5.35）°，與術前比較差異均有統計學意義（P lt; 0.05）。隨訪期間無骨溶解，廣泛X線透亮帶，假體進行性下沉、內翻、假體翻修等并發癥發生。結論Becker V形外旋截骨可用于CroweⅣ型DDH的THA治療，并獲得較好療效。

引用本文： 李永旺,馬文海,孫俊英,宋興建,安明,張謙. Becker V形外旋截骨在CroweⅣ型發育性髖關節脫位人工全髖關節置換術中的應用. 中國修復重建外科雜志, 2013, 27(9): 1032-1036. doi: 10.7507/1002-1892.20130225 復制

1.	Kiliço?lu O, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
2.	Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg (Am), 1976, 58(6): 838-845.
3.	Mallory TH, Lombardi AV Jr, Fada RA, et al. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res, 1999, (358): 166-172．.
4.	Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips: technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297): 71-81.
5.	Anwar M, Sugano N, Masuhara K, et al. Total hip arthroplasty in the neglected congenital dislocation of the hip: a five-to 14-year follow-up study. Clin Orthop Relat Res, 1993, (295): 127-134.
6.	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.
7.	Mendes DG. The role of computerized tomography scan in preoperative evaluation of the adult dislocated hip. Clin Orthop Relat Res, 1981, (161): 198-202.
8.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Supple 1): 68-73.
9.	孫俊英, 郝躍峰, 楊沛彥, 等. 股骨轉子下疊加縮短截骨在Crowe Ⅳ型成人髖脫位全髖置換術的應用. 中華骨科雜志, 2008, 28(1): 9-13.
10.	Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
11.	Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral component: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
12.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
13.	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
14.	Latimer HA, Lachiewicz PF. Porous coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg (Am), 1996, 78(7): 975-981.
15.	Dorr LD. Acetabular cup position: the imperative of getting it right. Orthopedics, 2008, 31(9): 898-899.
16.	Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
17.	Togrul E, Özkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hi replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470．.
18.	Reikeraas O, Lereim P, Gabor I, et al. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand, 1996, 67(1): 33-36.
19.	張洪. 髖關節發育不良診斷和治療中的問題與對策. 中華外科雜志, 2008, 46(17): 1284-1287.
20.	Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty, 2009, 24(2): 180-186.

1. Kiliço?lu O, Türker M, Akgül T, et al. Cementless total hip arthroplasty with modified oblique femoral shortening osteotomy in Crowe type IV congenital hip dislocation. J Arthroplasty, 2013, 28(1): 117-125.
2. Dunn HK, Hess WE. Total hip reconstruction in chronically dislocated hips. J Bone Joint Surg (Am), 1976, 58(6): 838-845.
3. Mallory TH, Lombardi AV Jr, Fada RA, et al. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res, 1999, (358): 166-172．.
4. Paavilainen T, Hoikka V, Paavolainen P. Cementless total hip arthroplasty for congenitally dislocated or dysplastic hips: technique for replacement with a straight femoral component. Clin Orthop Relat Res, 1993, (297): 71-81.
5. Anwar M, Sugano N, Masuhara K, et al. Total hip arthroplasty in the neglected congenital dislocation of the hip: a five-to 14-year follow-up study. Clin Orthop Relat Res, 1993, (295): 127-134.
6. 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.
7. Mendes DG. The role of computerized tomography scan in preoperative evaluation of the adult dislocated hip. Clin Orthop Relat Res, 1981, (161): 198-202.
8. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Supple 1): 68-73.
9. 孫俊英, 郝躍峰, 楊沛彥, 等. 股骨轉子下疊加縮短截骨在Crowe Ⅳ型成人髖脫位全髖置換術的應用. 中華骨科雜志, 2008, 28(1): 9-13.
10. Mulliken BD, Bourne RB, Rorabeck CH, et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability. J Bone Joint Surg (Am), 1996, 78(8): 1214-1225.
11. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral component: a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
12. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
13. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
14. Latimer HA, Lachiewicz PF. Porous coated acetabular components with screw fixation. Five to ten-year results. J Bone Joint Surg (Am), 1996, 78(7): 975-981.
15. Dorr LD. Acetabular cup position: the imperative of getting it right. Orthopedics, 2008, 31(9): 898-899.
16. Argenson JN, Ryembault E, Flecher X, et al. Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg (Br), 2005, 87(9): 1192-1196.
17. Togrul E, Özkan C, Kalaci A, et al. A new technique of subtrochanteric shortening in total hi replacement for Crowe type 3 to 4 dysplasia of the hip. J Arthroplasty, 2010, 25(3): 465-470．.
18. Reikeraas O, Lereim P, Gabor I, et al. Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases. Acta Orthop Scand, 1996, 67(1): 33-36.
19. 張洪. 髖關節發育不良診斷和治療中的問題與對策. 中華外科雜志, 2008, 46(17): 1284-1287.
20. Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty, 2009, 24(2): 180-186.

《中國修復重建外科雜志》

Becker V形外旋截骨在CroweⅣ型發育性髖關節脫位人工全髖關節置換術中的應用

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《中國修復重建外科雜志》

Becker V形外旋截骨在CroweⅣ型發育性髖關節脫位人工全髖關節置換術中的應用

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