成人髋臼发育不良全髋置换的髋臼重建

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成人髋臼发育不良全髋置换的髋臼重建

潘兵 张志敬 李战友

摘要　目的　探讨应用全髋关节置换术治疗髋臼发育不良继发骨性关节炎时臼杯假体安放的方法及其对手术疗效的影响。方法　对48例(56髋)髋臼发育不良行全髋置换时,部分应用髋臼内陷成形术向内或内下方加深髋臼并选择小型臼杯假体。通过Ranawat 三角测量术前及术后股骨头中心距理想旋转中心的水平和垂直距离,应用M ark 髋臼四分法判断臼杯假体的实际位置。行Harris 临床评分及X 线检查做为疗效判定标准。结果　Ranaw at 三角测量,术前股骨头中心距理想旋转中心的水平距离平均为18.2mm ,术后为1.52mm ;术前垂直距离平均为10.26mm ,术后为5.68mm 。手术前后比较,差异有统计学意义(P <0.01)。M ark 髋臼四分区中,臼杯假体位于内侧区者为46髋,其中内下区34髋。术前Harris 评分为32.5～60.3分,术后为76.6～96.5分。无假体松动和移位,无翻修病例。结论　在髋臼发育不良行全髋置换的髋臼重建中,应强调向内方或内下方加深髋臼,接近于真臼安放臼杯假体,以尽量恢复髋关节理想旋转中心;选择小型臼杯假体以获得髋臼宿主骨的良好覆盖,减少髋臼植骨的机会。

关键词　髋关节;髋臼发育不良;关节成形术;置换;重建

Acetabular Reconstruction of Total Hip Arthroplasties for Dysplatic Acetabulum in Adults

Pan Bing ,Zhang Zhijing ,Li Z hanyou .Department of Orthopedics ,117th Hospital of PL A ,Hangzhou ,310013

A bstract Objective To ex plore the methods and the effects of placement of the acetabular components in treatment of degenerative o s -teoarthrosis secondary to congenital dysplasia o f acetabulum with to tal hip arthroplasties (T HA ).Methods I n hip replacement with small cup components for 48patients (56hips ),the acetabula were deepened an ostetory of acctabular medial wall (co ty loidplasty )was used .The Ranawat triangle w as separately used to measure horizontal and vertical distances betw een the femoral head center and the op -timal ro tating center .T he initial position of the acetabular cup was assessed by the M ark four -zo ne system .T he results was evalua ted w ith the Harris hip sco re sy stem and radiographic parameters .Results T he mean horizo ntal distance was 18.2mm preoperatively and 1.52mm postopera tiv ely ,and the mean ver tical distance was 10.26mm preoperatively and 5.68mm postoperatively .T here w as statisti -cal difference (P <0.01).With use of the four -zone classification described ,46cups were in medial region ,34of the 46cups were in region of inferior and medial ,accounting fo r 68percent of total cups .T he Harris hip score w as 32.5～60.3points preoperatively and 76.6～96.5points postoperatively .No patients had revision ,loosening o r migration of the acetabular component .Conclusion W e sugg est that the acetabulum tow ards medial region o r inferior and medial region be deepened ,and the acetabulum be reco nstructed by po -sitioning the hip center as close as possible to the anatomic hip center .I t is emphasized to try to recovery the optimal ro tating center in the T HA .A small cup can obtain adequate coverage o f the socket by the ilium ,and can reduce the use of bone -grafting .Key words Hip joint ;Dysplatic acetabulum ;Arthroplasty ;Replacement ;Reconstruction

全髋关节置换术治疗髋臼发育不良性骨关节炎较常规置换困难,技术难点主要集中在髋臼侧,髋

臼复杂多样的畸形,造成了临床上多种髋臼重建的模式。笔者于1998年2月～2005年11月,对48例(56髋)髋臼发育不良性骨性关节炎患者行全髋关节置换术,临床疗效满意。现报告如下。

1　临床资料

1.1　一般资料　本组48例(56髋),男5例(5髋),女43例(51髋);年龄40～68岁。右侧14髋,左侧32髋,双侧

10髋;所有病例均有患髋持续性疼痛、跛行及功能障碍。X 线检查髋关节脱位按Crowe 分类:Ⅰ型20髋,Ⅱ型28髋,Ⅲ型8髋。髋臼侧采用非骨水泥型髋臼杯假体固定51髋,骨水泥型5髋。股骨侧非骨水泥型假体固定48髋,骨水泥型8髋。臼杯假体安置于真臼内者38髋,安放于真臼偏高位18髋。髋臼加深内移后臼内壁保持完整26髋,采用臼壁内陷成形技术30髋,髋臼结构性植骨6例。安放小型号髋臼假体(臼杯外径<44mm )46例,小型臼杯假体者均配置22mm 的股骨头假体。患髋曾有手术史6例,其中切开复位

解放军第117医院骨科　浙江省杭州市　310013