| 采用小臼杯置换与髋臼加深行全髋关节置换治疗Crowe Ⅳ型髋脱位 |
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投稿时间：2009-03-31
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| 作者 | Author | 单位 | Address | E-Mail |
| 孙俊英 |
SUN Jun-ying |
苏州大学附属第一医院骨科,江苏 苏州 215006 |
Department of Orthopaedic,the First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu,China |
sunjunying@hotmail.com |
| 郝跃峰 |
HAO Yue-feng |
苏州大学附属第一医院骨科,江苏 苏州 215006 |
Department of Orthopaedic,the First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu,China |
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| 杨沛彦 |
YANG Pei-yan |
苏州大学附属第一医院骨科,江苏 苏州 215006 |
Department of Orthopaedic,the First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu,China |
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| 杨玉生 |
YANG Yu-sheng |
苏州大学附属第一医院骨科,江苏 苏州 215006 |
Department of Orthopaedic,the First Affiliated Hospital of Suzhou University,Suzhou 215006,Jiangsu,China |
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| 期刊信息：《中国骨伤》2009年，第22卷，第6期，第407-409页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的：总结Crowe Ⅳ型先天性髋脱位采用小臼杯置换和髋臼加深行全髋关节置换术治疗的手术方法和疗效。
方法：自2000年1月至2005年12月，共收治14例(16髋)患者，其中男2例，女12例；单髋12例，双髋2例；年龄38～75岁，平均49岁。所有患者均符合Crowe分型标准的Ⅳ型诊断。手术指征：因髋关节严重疼痛和下肢不等长影响日常行走和活动者。臼杯均采用金属杯+聚乙烯内衬组装设计，外径42～44 mm,内径22.225 mm,聚乙烯内衬厚6～7 mm,其中Duraloc(Depuy, Warsaw, USA)10髋，Pressfit SⅡ(LINK,Germany)6髋。全部患者均采用髋臼内壁磨锉加深，以改善髋臼对臼杯的覆盖，无一例因臼杯覆盖不满意而采用大块骨植骨加盖。评定指标：手术前、后的髋关节功能均采用Harris标准评分，臀中肌按5级肌力标准和Trendelenburg征检查。术后X线摄片检查包括臼杯的固定区域(真臼区的大小和位置按Ranawat三角测量法确定)、覆盖度(以臼杯最内和最外缘距离的百分率表示)以及外展角等。
结果：术后X线摄片显示臼杯负重区获髋臼覆盖达98%以上，臼杯平均从Ranawat三角内移(5.8±1.2) mm,上移(6.2±1.7) mm.随访3～9年，髋关节功能从术前的25～32分改善至手术后1年的90～98分。X线片显示：加深后的髋臼内壁缺损和骨水泥覆盖区均在手术4～8个月后获骨性愈合，聚乙烯内衬线性磨损率每年(0.10±0.03) mm,至今无一髋需行翻修术治疗，也无一髋假体显示有肯定松动或可能松动以及骨溶解。
结论：采用小臼杯置换与髋臼加深行全髋关节置换术治疗Crowe Ⅳ型髋脱位具有手术简单、创伤小、恢复快等优点，且早、中期疗效满意。 |
| 【关键词】关节成形术,置换,髋 髋脱位,先天性 髋臼 治疗效果 |
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| Total hip replacement for the treatment of Crowe Ⅳ congenital hip dislocation using small acetabular components combined with medial protrusio technique |
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ABSTRACT
Objective: To summarize the surgical technique and the clinical results of small acetabular components combined with medial protrusio technique in primary total hip arthroplasty(THA) for the treatment of Crowe type Ⅳ congenital hip dislocation (CHD).
Methods: From January 2000 to December 2005,total 14 patients (16 hips) of Crowe type Ⅳ CHD underwent cementless THA (12 unilateral,2 bilateral) with this new technique. There were 2 males and 12 females with an average age of 49 years(range,38 to 75 years). The indications for surgery was severe hip pain and leg length discrepancy with difficulty in walking and activating. Cup design:Duraloc(Depuy,Warsaw,USA)in 10 hips,Pressfit SⅡ(LINK,Germany)in 6 hips. The outside diameter of the cup was 42 to 44 mm;and the thickness of the polyethylene liner was 6 to 7 mm. Total hip replacement were performed with the medial protrusion technique to stabilize the fit of a hemispherical metal cup in the acetabulum. The hip functions were evaluated by Harris hip score. The muscle strength of the gluteus medius and gait were respectively evaluated in accordance with the standards of five and four classes.
Results: The X-ray showed that the average superolateral bone coverage in these 16 hips(none of which had bone graft) was more than 98 percent. The cup was an average of(5.8±1.2) mm medial and(6.2±1.7) mm superior to the Ranawat triangle. The follow-up period ranged from 3 to 9 years. The Harris hip score improved from 25 to 32 preoperatively to 90 to 98 1 year postoperatively. X-ray showed that perforated area of the medial acetabulum were repaired with healed bone mud 4 to 8 months after operation. The rate of linear wear of the polyethylene liner averaged(0.10±0.03) mm each year. Until now,no aseptic loosening or osteolysis was identified around the acetabulum components, no acetabular components were revised for loosening or other reasons.
Conclusion: Small acetabular components combined with medial protrusio technique is a simple,reliable and flexible surgical technique. Early and mid-term result in total hip arthroplasty with this technique for the treatment of Crowe type Ⅳ CHD is satisfactory. |
| KEY WORDS Arthroplasty,replacement,hip Hip dislocation,congenital Acetabulum Treatment outcome |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙俊英,郝跃峰,杨沛彦,杨玉生.采用小臼杯置换与髋臼加深行全髋关节置换治疗Crowe Ⅳ型髋脱位[J].中国骨伤,2009,22(6):407~409 |
| 英文格式: | SUN Jun-ying,HAO Yue-feng,YANG Pei-yan,YANG Yu-sheng.Total hip replacement for the treatment of Crowe Ⅳ congenital hip dislocation using small acetabular components combined with medial protrusio technique[J].zhongguo gu shang / China J Orthop Trauma ,2009,22(6):407~409 |
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