两种不同截骨方法治疗Crowe Ⅳ型先天性髋脱位的比较研究

摘要

目的 探讨对成人Crowe Ⅳ型先天性髋脱位患者(congenital dislocated hip,CDH)行人工全髋关节置换术(total hip arthroplasty,THA)时两种不同截骨方法的效果及适应证选择.方法 回顾性分析我科2003年4月至2007年10月行THA治疗的36例单侧Crowe Ⅳ型CDH患者的临床资料,通过测量下肢长度差、旋转中心高度差及Harris评分等指标比较股骨近端截骨和粗隆下截骨的效果.股骨近端截骨组20例,股骨粗隆下截骨组16例.结果 手术均成功复位,粗隆下截骨组手术时间较短,术后下肢长度差近端股骨截骨组平均为0.3 cm(-1.0～1.5 cm),粗隆下截骨组平均为0.6 cm(0～1.5cm).两组间比较无显著差异(P＞0.05).髋臼角、旋转中心高度差以及重力臂的比较无显著差异.术中、术后并发症的发生率股骨近端截骨组明显高于粗隆下截骨组.最近一次随访,Harris评分近端股骨截骨组为(83±8)分,粗隆下截骨组为(90±6)分,两组间比较差异具有统计学意义(P＜0.05).结论 严重的成人Crowe Ⅳ型CDH行THA时通过两种截骨方式均能有效恢复患肢长度、重建关节功能,但对于脱位过高的患者(＞4 cm)采用股骨近端截骨容易出现并发症,粗隆下截骨是一种很好的选择.%Objective To compare proximal femoral resection with transverse subtrochanteric osteetomy in the treatment of Crowe' s Ⅳ congenital dislocated hip (CDH) with total hip arthroplasty (THA).Methods Thirty-six primary hip arthroplasfies were performed in patients with Crowe grade Ⅳ CDH from April 2003 to October 2007.These patients were divided into two groups, one for proximal femoral resection (n =20) and another for subtrochanteric osteotomy (n = 16).The leg length discrepancy,rotation center height and Harris score were measured pre-and post-operation to compare the two osteotomic methods.Results All surgeries were successfully performed.The average leg discrepancy was 0.6 cm ( range from 0 to 1.5 cm) for subtrochanteric osteotomy group and 0.3 cm( range from-1.0 to 1.5 cm)for proximal femoral resection group, there was no significant difference between them ( P ＞ 0.05 ).There were also no statistically significant difference between the two groups in other index.The complication rates were much higher in the proximal femoral resection group. At the latest follow up, the Harris score of subtrochanteric ostcotomy group was 90 ± 6, and the proximal femoral resection group was 83 ± 8.There was statistical difference between the two groups ( P ＜ 0.05 ) .Conclusions Although both the femoral shortening techniques can restore the leg length of Crowe Ⅳ CDH, the subtrochanteric osteotomy technique owns advantage of avoiding the potential comphcatioas in the high riding patients (high dislocation ＞4 cm).