高旋转中心全髋关节置换术治疗CroweⅡ、Ⅲ型髋关节发育不良

发布时间：2018-04-27 19:05

本文选题：人工全髋关节置换术 + 发育性髋关节发育不良　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的：拟探讨人工全髋关节置换术(Total hip arthroplasty,THA)治疗CroweⅡ、Ⅲ型发育性髋关节发育不良(Developmental dysplasia of the hip,DDH),非骨水泥臼杯高位安放的短期临床及放射学结果。方法：回顾2011年6月至2013年6月,29例(37髋)CroweⅡ、Ⅲ型髋关节发育不良患者接受人工全髋关节置换术,其臼杯高于解剖旋转中心安放(高旋转中心组)。选择同时期的28例(35髋)CroweⅠ型患者作为对照。比较两组患者的髋关节Harris评分、步态、跛行、Trendelanburg征、放射学检查旋转中心相对于泪滴连线的垂直距离(旋转中心高度)、相对于泪滴垂线的水平距离,双下肢长度差异以及有无放射学透亮线。结果：平均随访2.2年。CroweⅡ、Ⅲ型的臼杯旋转中心距泪滴连线的平均垂直距离分别为25.5mm、29.7mm,与CroweⅠ型(18.7mm)比较有显著统计学差异(P=0.02)。CroweⅡ、Ⅲ型臼杯旋转中心距泪滴垂线的水平距离分别为27.4 mm、28.4 mmm。、与CroweⅠ型(27.8 mm)比较无显著统计学差异(P=0.23)。术后双下肢长度差异：臼杯高位安放组CroweⅡ型患者平均为3.3 mm,CroweⅢ型为3.6 mm,解剖位安放臼杯的Ⅰ型DDH为3.2 mm。臼杯高位组与解剖位组比较无显著统计学差异(P=0.17)。末次随访时,高旋转中心组的平均Harris评分为92.3分(86-98分),对照组的平均Harris评分为92.8分(84-100分),两组比较无显著统计学差异(P=0.57)。所有患者步态良好,无跛行,Trendelanburg征阴性。结论：人工全髋关节置换术治疗CroweⅡ、Ⅲ型DDH时,臼杯高位安放是一种可靠的方法,可以获得良好的宿主骨覆盖,短期临床及放射学结果良好。但需要将旋转中心尽量内移,另外需要恢复偏距并保证双下肢等长,以恢复臀中肌张力,增强臀中肌力量。
[Abstract]:Objective: To investigate the short-term clinical and radiological results of Total hip arthroplasty (THA) in the treatment of Crowe II, type III developmental dysplasia of the hip (Developmental dysplasia of the hip, DDH), and the high placement of the non cement mortar cup. Methods: retrospective June 2011 to June 2013, 29 cases (37 hips) Crowe II, type III Patients with dysplasia of the hip received total hip replacement. The cup was higher than the anatomical rotation center (high rotation center). 28 patients (35 hips) of the same period (35 hips) Crowe I patients were selected as control. The hip joint Harris score, gait, claudication, Trendelanburg sign, and radiological examination of the rotation center relative to the tear drop of the two groups were compared. The vertical distance (the height of the rotation center), the horizontal distance relative to the tear vertical line, the difference of the length of the lower limbs and the radiographic bright line. Results: the average follow-up of the average follow-up of 2.2 years.Crowe II, the average vertical distance between the center of the cup rotation of the type III cup and the tear line was 25.5mm, 29.7mm, compared with the Crowe type I (18.7mm). The horizontal distance between P=0.02.Crowe II and type III cup rotation center was 27.4 mm and 28.4 mmm., respectively, and there was no significant difference from Crowe type I (27.8 mm) (P=0.23). The difference of the length of lower extremities after operation was 3.3 mm, Crowe III was 3.6 mm, and the anatomic position was placed in the cup. There was no significant difference between the 3.2 mm. cup high position group and the anatomic group (P=0.17). At the last follow-up, the average Harris score of the high rotation center group was 92.3 (86-98), the average Harris score of the control group was 92.8 (84-100), and there was no significant statistical difference (P=0.57) in the control group (P=0.57). All patients had good gait, no limp, Tre Conclusion: ndelanburg is negative. Conclusion: when Crowe II and type III DDH are treated by total hip arthroplasty, high placement of the cup is a reliable method, which can obtain good host bone cover and good short-term clinical and radiological results. However, the rotation center should be moved as far as possible, and the offset distance should be restored and the equal length of the lower extremities should be restored to restore the buttock. The muscle tension of the middle muscle strengthens the strength of the gluteus medius.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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