目的：探讨非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良的临床疗效。方法2007年10月至2010年1月应用非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良患者32例，男12例，女20例；年龄23~60岁，平均（49.4±9.7）岁。对侧髋关节正常15例，无关节炎及脱位表现的轻度髋臼发育不良17例。通过有限软组织松解、撬拨复位实现真臼重建，不行股骨短缩截骨。术后对患者满意度、髋关节功能恢复、双下肢不等长、骨盆倾斜等情况进行评估。结果所有患者均获得随访，随访时间1~6年，平均（4.0±1.5）年。Harris髋关节评分由术前（36.5±10.3）分（20~63分）提高至末次随访时（89.8±4.9）分（80~97分），两者差异有统计学意义。Harris髋关节评估优16例、良16例，优良率100%。患者满意率93.8%（30/32）。术后均有不同程度的骨盆向患侧倾斜，随时间延长双下肢相对长度差逐渐缩小，骨盆倾斜逐渐矫正。末次随访时双下肢相对长度差（7.3±4.4）mm，髂腰角-0.1°±1.4°。9例出现术后膝关节轻度外翻，末次随访时仍有4例残存膝关节轻度外翻，长距离行走出现大腿外侧及膝关节酸胀不适。2例有术后股神经牵拉损伤，未行特殊处理，分别于术后1个月和3个月完全恢复。随访期间无髋关节脱位、假体感染、假体松动或失败发生。结论在脊柱柔韧性较好的前提下，通过非截骨全髋关节置换术治疗单侧CroweⅣ型髋关节发育不良可获得令人满意的手术效果，术后短期内的术侧肢体过长会随着骨盆倾斜的恢复而逐渐得到矫正。%Objective To evaluate the clinical efficacy of total hip arthroplasty (THA) with no femoral shortening oste⁃otomy for unilateral CroweⅣ developmental dysplasia of hip. Methods From October 2007 to January 2010, 32 patients with CroweⅣdevelopmental dysplasia of hip in one side underwent THA, including 20 females and 12 males, with an average age of 49.4 ± 9.7 years (range, 23-60 years). There were 15 cases as normal and 17 as mild developmental dysplasia of hip in the other side. The THA were performed with requisite soft tissue release and direct leverage using an elevator but with no femoral shorten⁃ing osteotomy. The patients' satisfaction, Harris hip score, bilateral leg⁃length discrepancy and pelvic obliquity was used to assess the clinical results. Results All of patient were followed up for 1-6 years, average 4.0 ± 1.5 years. No loosening or failure of component occurred by the end of follow⁃up. The Harris hip score was improved from preoperative 36.5±10.3 (20-63) to 89.8± 4.9 (80-97), and the excellent and good rate was 100% (excellent 16 cases, good 16 cases). The satisfactory rate was 93.8%(30/32). The leg⁃length discrepancy of the bilateral sides and the pelvic obliquity was corrected gradually and the gait returns to normal. Nine cases have valgus knee after THA and 4 cases of them felt uncomfortable after long⁃distance walk. Femoral nerve injury occurred in 2 cases. All of cases recovered after 1 and 3 months respectively. No infection and dislocation oc⁃curred. Conclusion THA with no femoral shortening osteotomy can achieve good clinical results in patients with unilateral CroweⅣdevelopmental dysplasia of hip. The discrepancy of leg⁃length will be diminished with the correction for pelvic obliquity.
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