Objective To investigate short-term efficacy of acetabular reconstruction with autogenous bone dust graft on the original acetabulum in total hip arthroplasty (THA) for developmental hip dysplasia (DDH) in adult patients.Methods Twenty two patients (24 hips) with osteoarthritis secondary to DDH underwent THA with acetabular reconstruction and autogenous bone dust graft at the true acetabulum from January 2010 to December 2014.There were 7 male (8 hips) and 15 female (16 hips) patients,the Harris scores were (48.3 ± 14.3) points preoperatively,and the mean length difference was (2.9 ± 0.6) cm between two lower limbs of the unilateral DDH patients.The radiological examinations of acetabular prosthesis and bone grafts were performed preoperatively and during the follow-up,while the clinical efficacy was assessed using Harris hip score.Results The mean graft coverage was (23.2 ± 4.6)％,the anteroposterior diameter and width of the socket uncovered during operative evaluation were (14.0 ± 1.7) and(22.1 ± 3.2)mm,respectively.All of the hip rotation center were reconstructed inside the Ranawat triangle,and the mean vertical and horizontal distance between rotation center and inter-teardrop line was (28.1 ± 3.2) and (21.8 ± 1.9)mm,respectively.After operation,20 patients(22 hips) were followed up for 1.5-4 years,averagely(2.4 ± 0.8)years.No nerve damage,loosening or revision of acetabular component was seen in those patients.At last follow-up,the Harris score was (87.3 ± 7.4) points,and the length difference was (0.6 ± 0.3) cm between two lower limbs,showing statistically differences (both P＜ 0.05) when compared with those preoperatively.Radiographs showed that all bone graft was fused to host bone.Within the first year after replacement,the bone graft was partially absorbed in 3 patients,but 2 cases began to grow later.And 2 hips developed grade 1 Brooker heterotopic ossification,none of these has further development.Conclusion For DDH,acetabular reconstruction using autogenous bone dust graft on the original acetabulum in THA is a liable method.The satisfying short-term clinical and radiographic results can be achieved by this method,and its optimal operative indication and long-term efficacy remains to be studied.%目的 探讨全髋关节置换(THA)真臼重建联合自体骨泥植骨治疗成人髋关节发育不良(DDH)的早期临床效果.方法 采用THA真臼重建联合自体骨泥植骨治疗DDH22例(24髋),男7例(8髋),女15例(16髋);年龄41～68(54±8.75)岁.术前Harris评分(48.2±14.3)分,除2例双侧患者外,其余患者下肢不等长均＞2cm,平均(2.9±0.6)cm.术后随访X线片评价髋臼假体位置、植骨块愈合情况以及下肢长度.结果 术中试模外露骨缺损区的内外径和前后径分别为(14.0±1.7)和(22.1±3.2)mm,术后髋关节前后位X线片示植骨区覆盖率为(23.2±4.6)％,臼杯旋转中心距泪滴连线的水平和垂直距离分别为(28.1±3.2)和(21.8±1.9)mm,髋关节旋转中心均在Ranawat三角内.术后20例(22髋)获得随访,随访时间1.5～4(2.4±0.8)年.无感染、神经损伤、臼杯松动及翻修病例.末次随访时Harris评分为(87.3±7.4)分,双下肢长度差为(0.6±0.3)cm,与术前相比,差异均有统计学意义(均P＜0.05).影像学上所有的植骨区均与宿主骨愈合,有3例患者术后1年内可见植骨区轻度骨吸收,有2例后期随访时重新见骨长入,另有2例患者出现异位骨化,均为Brooker l度,后期随访未见进展.结论 THA真臼重建联合自体骨泥植骨治疗DDH,早期临床效果令人满意,檀骨重建良好,其最佳手术适应证及远期效果有待进一步研究.
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