自体股骨头结构植骨重建髋臼辅助THA在改良CROWE Type ⅣB型DDH中的临床疗效分析

Clinical effectiveness of total hip arthroplasty with structural femoral head autografting for acetabular reconstruction in the treatment of revised Crowe type ⅣB developmental dysplasia of the hip

摘要:

目的 分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术（total hip arthroplasty，THA）治疗改良Crowe Type ⅣB型成人髋关节发育不良性脱位（developmental dysplasia of the hip，DDH）患者的临床疗效。方法 按照改良Crowe分型，选取山东大学齐鲁医院德州医院关节外科2015年8月至2023年3月收治的Type ⅣB型DDH患者26例，其中男25例，女1例，采用自体股骨头结构植骨重建髋臼辅助THA，记录患者手术时间、术中失血量、术中术后输血量、术后血红蛋白、手术相关并发症和骨愈合时间等，并行骨盆正位X线片了解假体位置、假体骨长入、假体松动以及骨愈合情况等，采用视觉模拟评分表（visual analogue scale，VAS）评价髋关节的疼痛不适，采用髋关节Harris评分和Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）来评价髋关节功能及临床疗效。结果 所有患者的平均随访时间（9.73±8.35）个月，术中出血平均为（715.38±143.37） mL，术中平均输血（415.38±282.41） mL，手术时间平均为（118.62±18.27） min，术后平均输血为（192.31±236.51） mL。所有患者转子下骨端、自体股骨头和假臼之间均骨愈合良好。髋关节VAS评分从术前6.73±0.45，至术后末次随访时VAS评分1.73±0.53，差异有统计学意义（P=0.000），髋关节活动度均较术前明显改善，髋关节Harris评分从术前24.27±1.66，至术后末次随访时Harris评分74.77±2.89，差异有统计学意义（P=0.000），WOMAC术前术后评分分别为130.08±5.72和67.85±3.23，差异均有统计学意义（P=0.000）。结论 自体股骨头结构植骨重建髋臼辅助THA治疗改良Crowe Type ⅣB型DDH，具有操作相对简单、固定牢固、手术相对安全和疗效确切的优点。

Abstract:

Objective To analyze and summarize the clinical effectiveness of total hip arthroplasty（THA） with structural femoral head autografting for acetabular reconstruction in the treatment of adult patients with revised Crowe type ⅣB developmental dysplasia of the hip（DDH）.Methods We included 26 patients（25 males and 1 female） who were diagnosed with type ⅣB DDH according to the revised Crowe classification and underwent THA with structural femoral head autografting for acetabular reconstruction in the Department of Joint Surgery，Qilu hospital of Shandong University Dezhou hospital from August 2015 to March 2023. The surgical time，intraoperative blood loss，intraoperative blood transfusion volume，postoperative blood transfusion volume，postoperative hemoglobin content，surgical complications，and bone healing time were recorded. Anteroposterior pelvic X-rays were taken to examine prosthetic position，bone ingrowth，prosthetic loosening，and bone healing. The visual analogue scale（VAS） score was used to assess the intensity of pain in the hip. The Harris hip score and the Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC） were used to evaluate hip function and clinical effectiveness.Results For all the cases，the mean follow-up time was （9.73±8.35） months，the mean intraoperative blood loss was （715.38±143.37） mL，the mean intraoperative blood transfusion volume was （415.38±282.41） mL，the mean surgical time was （118.62±18.27） min，and the mean postoperative blood transfusion volume was （192.31±236.51） mL. All the patients had good healing between the subtrochanteric region，femoral head autograft，and false acetabulum. The hip VAS score showed a significant decline from （6.73±0.45） points before operation to （1.73±0.53） points at the last follow-up after operation（P<0.001）. The ranges of motion of the hip joint were all significantly improved. The Harris hip score was increased significantly from （24.27±1.66） points before surgery to （74.77±2.89） points at the last follow-up after surgery（P<0.001）. The WOMAC score showed a significant decrease from （130.08±5.72） points before surgery to （67.85±3.23） points after surgery（P<0.001）.Conclusion THA with structural femoral head autografting for acetabular reconstruction is a relatively simple procedure to perform，with good fixation，safety，and effectiveness for the treatment of revised Crowe type ⅣB DDH.