大头陶瓷-陶瓷人工全髋关节置换术治疗成人先天性髋关节发育不良

摘要

目的 探讨大头陶瓷-陶瓷人工全髋关节置换术治疗成人先天性髋关节发育不良的临床疗效.方法 对51例先天性髋关节发育不良患者(62髋)行大头陶瓷-陶瓷人工全髋关节置换术,术后皮牵引固定,对疗效进行评价.结果 51例均获随访,时间20 ～63 (35.1 ±6.2)个月.患者切口均一期愈合.2例术后出现股神经麻痹症状,3个月后恢复正常;1例出现轻度跛行.未出现脱位、感染、下肢深静脉血栓等并发症.术后患侧肢体较术前延长2 ～5 cm.术后5个月,患者均可下床活动且恢复日常生活及工作.根据Harris评分标准:疼痛评分术前为15 ～25(18.5±3.5)分,术后为33 ～42(38.1±2.6)分,差异有统计学意义(P＜0.05).髋关节功能评分由术前的9～18(15.4±2.3)分增加到末次随访时的37～45(40.3±1.8)分,差异有统计学意义(P＜0.05);屈髋活动度术前为65°～120°(81.5°±10.1°),术后为92°～135°(118.5°±7.6°),差异有统计学意义(P＜0.05).结论 大头陶瓷-陶瓷人工全髋关节置换术治疗成人先天性髋关节发育不良临床疗效满意.%Objective To discuss the clinical efficacy of congenital dysplasia of hip in adults treated with large femoral head in ceramic-on-ceramic total hip prosthesis. Methods 51 patients (62 hips) of congenital dysplasia of hip were treated with large femoral head in ceramic-on-ceramic total hip prosthesis. All patients were treated with skin traction after operation. The efficacy of the operation was evaluated. Results 51 cases were followed up for 20～63 (35. 1 ± 6. 2) months. Healing of incision by first intention was achieved in all patients. There were 2 cases of femoral nerve palsy and recovered in 3 months. There was 1 case of claudication. The other patients with no dislocation, infection, and deep venous thrombosis of lower limbs occurred. The mean amount of postoperation leg lengthening was 2～5 cm. All patients could walk independently and return to previous job in 5 months postoperation. According to the standard of Harris score, the pain scores of preoperation was 15～25( 18. 5 ±3. 5)points, the postoperative score was 33～42 ( 38. 1 ± 2. 6 ) points, there was statistically significant difference ( P < 0. 05 ) . Hip function score improved from 9～18(15. 4±2. 3) points preoperation to 37～45(40. 3 ± 1. 8) points at last follow-up time, there was statistically significant difference(P < 0. 05 ) . The range of hip flexion were 65°～120° (81. 5° ± 10. 1°) and 92°～ 135° (118. 5° ± 7. 6°) before and after operation respectively (P < 0. 05). Conclusions The efficacy of large femoral head in ceramic-on-ceramic total hip prosthesis for congenital dysplasia of hip in adults is satisfied.