生物型臼杯高旋转中心安置全髋置换治疗成人CroweⅡ型髋关节发育不良短期疗效分析

发布时间：2018-04-28 15:45

本文选题：全髋关节置换术 + 髋关节发育不良　；参考：《青海大学》2017年硕士论文

【摘要】：目的:探讨生物型臼杯高旋转中心安置人工全髋置换术(Total hip arthroplasty,THA)治疗Crowe II型髋关节发育不良(Developmental dysplasia of the hip,DDH)的短期临床效果及影像学表现。资料与方法:组1:臼杯高位安置的继发骨性关节炎(OA)的Crowe II型DDH行THA的患者21例;组2:将同期因股骨头无菌性坏死行THA的44例患者中随机选取23例,臼杯解剖位安置。临床对比手术前后的WOMAC指数,跛行、步态,影像学对比术后旋转中心与双侧泪滴连线的垂直距离及水平距离、双下肢长度差。结果:组1患者随访平均19月,旋转中心距泪滴垂直距离30.89±7.29mm;组2随访平均19.6月,旋转中心距泪滴垂直距离19.87±4.66 mm,比较有显著统计学差异(P0.01)。组1和组2术后平均水平距离35.08±4.60mm、35.98±5.68mm,比较无统计学差异(P0.05)。组1术后下肢长度差为6.65±0.42mm,组2术后下肢长度差为6.59±0.47mm,比较无统计学差异(P0.05),最后一次随访,组1和组2 WOMAC指数为32.19±3.34分、31.91±3.09分,比较无统计学差异(P0.05)。术后WOMAC指数显著提高。术后两组患者均无感染、脱位、跛行,步态正常。结论:生物型臼杯高旋转中心安置对Crowe II型髋关节发育不良可获得初期的满意度,是一种可行的选择,术中依据患者髋臼周围骨量适量上移内移旋转中心,根据假体活动情况通过颈长及股骨侧假体大小调节偏距,纠正下肢的不等长度,达到双侧软组织张力平衡。
[Abstract]:Objective: to investigate the short term clinical effect and imaging findings of total hip arthroplasty (THA) in the treatment of Crowe II hip dysplasia (Crowe II) with high rotating center of acetabular cup. Materials and methods: group 1: 21 patients with Crowe type II DDH treated with Crowe type II DDH and group 2 were randomly selected from 44 patients who underwent THA because of aseptic necrosis of femoral head in the same period, and 23 patients were placed in acetabular cup anatomic position. WOMAC index, lameness, gait, vertical distance and horizontal distance between rotation center and bilateral tear drop were compared before and after operation. Results: the patients in group 1 were followed up for an average of 19 months, the vertical distance between rotation center and tear droplet was 30.89 卤7.29 mm, and that in group 2 was 19.6 months, and the vertical distance between rotation center and tear droplet was 19.87 卤4.66 mm, there was significant difference (P 0.01). The average horizontal distance between group 1 and group 2 was 35.08 卤4.60 mm to 35.98 卤5.68 mm, and there was no significant difference between group 1 and group 2 (P 0.05). The length difference of lower extremity was 6.65 卤0.42 mm in group 1 and 6.59 卤0.47 mm in group 2. There was no significant difference in the length of lower extremity between group 1 and group 2 (P 0.05). At the last follow-up, the WOMAC index of group 1 and group 2 was 32.19 卤3.34 and 31.91 卤3.09, respectively. There was no significant difference between group 1 and group 2 (P 0.05). The WOMAC index increased significantly after operation. No infection, dislocation, claudication and normal gait were observed in both groups. Conclusion: biotype acetabular cup high rotation center placement can obtain initial satisfaction for Crowe II hip dysplasia, and it is a feasible choice. According to the appropriate amount of periacetabular bone in patients, the rotation center should be moved up and inward during the operation. According to the movement of the prosthesis, the length of the neck and the size of the femoral side of the prosthesis were adjusted to correct the unequal length of the lower extremity and to achieve the balance of soft tissue tension on both sides.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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