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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2017, Vol. 10 ›› Issue (01) : 34 -39. doi: 10.3877/cma.j.issn.1674-6880.2017.01.007

所属专题： 文献；

论著

旋转中心内移结合上移重建髋臼技术治疗CroweⅡ、Ⅲ型成人发育性髋关节发育不良的疗效分析
朱贤平1,†(), 滕晓1, 泮宸帅1, 王湖兵1, 王勇1   
  1. 1. 318000　浙江台州，台州市中心医院（台州学院附属医院）骨科
  • 收稿日期:2016-12-27 出版日期:2017-02-01
  • 通信作者: 朱贤平

Efficacy of total hip arthroplasty in the treatment of Crowe Ⅱ and Ⅲ developmental dysplasia of hip in adults

Xianping Zhu1,†(), Xiao Teng1, Chenshuai Pan1, Hubing Wang1, Yong Wang1   

  1. 1. Department of Orthopedics, Taizhou Central Hospital (Affiliated Hospital of Taizhou University), Taizhou 318000, China
  • Received:2016-12-27 Published:2017-02-01
  • Corresponding author: Xianping Zhu
  • About author:
    Corresponding author: Zhu Xianping, Email:
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朱贤平, 滕晓, 泮宸帅, 王湖兵, 王勇. 旋转中心内移结合上移重建髋臼技术治疗CroweⅡ、Ⅲ型成人发育性髋关节发育不良的疗效分析[J]. 中华危重症医学杂志(电子版), 2017, 10(01): 34-39.

Xianping Zhu, Xiao Teng, Chenshuai Pan, Hubing Wang, Yong Wang. Efficacy of total hip arthroplasty in the treatment of Crowe Ⅱ and Ⅲ developmental dysplasia of hip in adults[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2017, 10(01): 34-39.

目的

探讨应用旋转中心内移结合上移重建髋臼技术在人工全髋关节置换术（THA）治疗CroweⅡ、Ⅲ型成人发育性髋关节发育不良（DDH）的疗效。

方法

选取台州市中心医院2006年4月至2014年7月接受THA治疗的DDH患者48例（58髋），按Crowe分型分为三组。研究组包括CroweⅡ型组14例（19髋）和CroweⅢ型组11例（14髋），均应用旋转中心内移结合上移重建髋臼技术；选取同期的CroweⅠ型患者23例（25髋）作为对照组，CroweⅠ型患者均使用解剖位重建髋臼技术。术后3个月、6个月及24个月通过影像学检查和Harris评分等评价患者术后功能。

结果

术后CroweⅠ、Ⅱ、Ⅲ型组患者臼杯旋转中心距泪滴连线的垂直距离[（18.3 ± 2.5）mm、（25.4 ± 3.2）mm、（29.6 ± 4.8）mm]、水平距离[（27 ± 5）mm、（21 ± 4）mm、（21 ± 4）mm]的比较，差异均有统计学意义（F = 10.992、11.271，P均< 0.05）。而三组间CE角的比较，差异无统计学意义[（16° ± 4°）、（17° ± 4°）、（16° ± 5°），F = 0.355，P > 0.05]。CroweⅠ型组与CroweⅡ、Ⅲ型组术前Harris评分的比较，差异有统计学意义[（51 ± 15）分vs.（43 ± 17）分，（51 ± 15）分vs.（39 ± 16）分，P均< 0.05]；而三组间术后3个月[（88 ± 10）分、（86 ± 12）分、（86 ± 13）分]、6个月[（89 ± 9）分、（88 ± 10）分、（85 ± 13）分]及24个月[（88 ± 9）分、（88 ± 10）分、（86 ± 10）分]随访的Harris评分比较，差异均无统计学意义（P均> 0.05）。随访末期所有患者Trendelanburg征阴性，步态良好，无跛行。

结论

Crowe Ⅱ、Ⅲ型成人DDH患者在THA中应用旋转中心内移结合上移重建髋臼技术是一种有效的方法，临床疗效及影像学结果满意。

关键词: 发育性髋关节发育不良, 人工全髋关节置换, Crowe分型
Objective

To investigate the short-term efficacy of total hip arthroplasty (THA) in the treatment of CroweⅡand Ⅲ developmental dysplasia of hip (DDH) in adults after displacing the hip center of rotation on inner and upper side.

Methods

Forty-eight DDH patients (58 hips) with THA treatment in Taizhou Central Hospital from April 2006 to July 2014 were enrolled and divided into the three groups based on Crowe types. The research groups including the CroweⅡgroup [n = 14 cases (19 hips)] and the Crowe Ⅲ group [n = 11 (14 hips)], were treated with the technique of displacing the hip center of rotation on inner and upper side during THA. The control group was the CroweⅠgroup [n = 23 (25 hips)], and was treated with the technique of anatomical reconstruction of acetabulum. The X-ray films on post-anterior position were rechecked on 3 days, 3 months, 6 months and 24 months after THA surgery. We evaluated the post-operation function with imaging examination and Harris score.

Results

The comparison of the mean vertical distance [(18.3 ± 2.5) mm, (25.4 ± 3.2) mm, (29.6 ± 4.8) mm] and horizontal distance [(27 ± 5) mm, (21 ± 4) mm, (21 ± 4) mm] between rotation center and inter-teardrop line in the CroweⅠ, Ⅱ and Ⅲ groups after surgery were significantly different (F = 10.992, 11.271; all P < 0.05). There were no statistical differences of CE angles in the CroweⅠ, Ⅱ, Ⅲ groups [(16° ± 4°), (17° ± 4°), (16°± 5°); F = 0.355, P > 0.05]. The mean Harris scores between CroweⅠgroups and CroweⅡ, Ⅲ groups before surgery were significantly different [(51 ± 15) vs. (43 ± 17), (51 ± 15) vs. (39 ± 16); all P < 0.05]. On 3 months [(88 ± 10), (86 ± 12), (86 ± 13)], 6 months [(89 ± 9), (88 ± 10), (85 ± 13)] and 24 months [(88 ± 9), (88 ± 10), (86 ± 10)] after surgery, the mean Harris scores among the three groups have no significant differences (all P > 0.05). All patients had excellent gait without lamp and with negative Trendelanburg syndrome at the end of follow-up period.

Conclusions

The technology of acetabular reconstruction which displaces the hip center of rotation on inner and upper side can be an effective method in treating CroweⅡ and Ⅲ DDH. The short-term clinical efficacy and radiographic results achieved by this method are satisfied.

Key words: Developmental dysplasia of the hip, Total hip arthroplasty, Crowe type
表1 三组发育性髋关节发育不良患者一般情况的比较（ ± s）
组别 例数 男/女（例） 年龄（岁） 体质量（kg） 身高（cm） BMI（kg/m2）
CroweⅠ型组 23（25髋） 3/22 54 ± 6 62 ± 8 164 ± 6 23.4 ± 1.9
CroweⅡ型组 14（19髋） 3/16 52 ± 7 63 ± 9 165 ± 7 22.1 ± 2.1
CroweⅢ型组 11（14髋） 1/13 55 ± 4 61 ± 6 163 ± 5 22.3 ± 2.2
F/χ2值 ? 0.568 1.383 2.100 1.168 1.426
P值 ? 0.753 0.270 0.144 0.326 0.192
图1 发育性髋关节发育不良患者的患髋正侧位X线片图。注：h为泪滴下缘的连线；v、v'为泪滴垂线；a、a'为臼杯旋转中心距泪滴垂线的水平距离；b、b'为臼杯旋转中心距泪滴下缘连线的垂直距离；β、β'为CE角
表2 术后三组发育性髋关节发育不良患者假体位置及臼杯旋转中心位置的比较（ ± s）
组别 例数 旋转中心距离泪滴连线垂直距离（mm） 旋转中心距离泪滴垂线水平距离（mm） CE角（°）
CroweⅠ型组 23（25髋） 18.3 ± 2.5 27 ± 5 16 ± 4
CroweⅡ型组 14（19髋） 25.4 ± 3.2a 21 ± 4a 17 ± 4
CroweⅢ型组 11（14髋） 29.6 ± 4.8a 21 ± 4a 16 ± 5
F值 ? 10.992 11.271 0.355
P值 ? < 0.001 < 0.001 0.705
表3 三组发育性髋关节发育不良患者Harris评分的比较（分， ± s）
组别 例数 术前 术后3个月 术后6个月 术后24个月
CroweⅠ型组 23（25髋） 51 ± 15 88 ± 10a 89 ± 9a 88 ± 9a
CroweⅡ型组 14（19髋） 43 ± 17b 86 ± 12a 88 ± 10a 88 ± 10a
CroweⅢ型组 11（14髋） 39 ± 16b 86 ± 13a 85 ± 13a 86 ± 10a
F值 ? 5.246
P值 ? 0.035
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