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目的:总结股骨短缩截骨结合全髋关节置换术治疗青年Crowe Ⅳ型髋关节发育不良(DDH)的近期疗效。方法:2009年1月至2015年1月期间我院收治的22例(24髋)青年Crowe Ⅳ型髋关节发育不良患者,其中男4例(5髋),女18例(19髋),年龄17~27岁,平均22岁。记录患者术前、术后髋关节功能Harris评分、髋关节疼痛VAS评分和下肢长度差异。收集患者临床及影像学资料。结果:22例患者均获随访,随访时间6~72个月,平均38个月。截骨端均骨性愈合,愈合时间3~6个月,平均3.2个月。Harris评分由术前(43.2±2.7)分改善至(95.3±2.8)分,效果显著(P<0.01),髋关节疼痛VAS评分由术前(6.0±1.0)分改善至(1.0±0.5)分,疼痛明显缓解(P<0.05),下肢长度差异由术前(55.5±15.5)mm减少至(16.5±5.5)mm,显著改善(P<0.01)。术后2例合并坐骨神经麻痹,但6个月内症状完全缓解,6例遗留轻度跛行。随访期间均无假体翻修,未发现材料与宿主的生物相容性反应。结论:股骨短缩截骨全髋置换术治疗青年Crowe IV型髋关节发育不良的近期疗效满意,术中综合考虑软组织松解程度与短缩截骨方式及长度可有效的解决患者肢体短缩、避免神经血管损伤及改善患者术后髋关节功能。
Objective: To summarize the short-term effect of femoral shortening osteotomy combined with total hip arthroplasty in the treatment of young Crowe type Ⅳ hip dysplasia (DDH). METHODS: Twenty-two (24 hips) young Crowe type IV hip dysplasia patients admitted to our hospital from January 2009 to January 2015 were enrolled. Among them, 4 were male (5 hips) and 18 female (19 hips) were male 17 ~ 27 years old, average 22 years old. The preoperative and postoperative hip function Harris score, hip pain VAS score and lower limb length were recorded. Collect patient’s clinical and imaging data. Results: Twenty-two patients were followed up for 6 to 72 months with an average of 38 months. Osteoid bone healing, healing time 3 to 6 months, an average of 3.2 months. The Harris score improved from 43.2 ± 2.7 to 95.3 ± 2.8, with significant improvement (P <0.01). The hip pain VAS score improved from preoperative 6.0 ± 1.0 to 1.0 ± 0.5 (P <0.05). The difference of the length of lower extremities was significantly reduced from 55.5 ± 15.5 mm to 16.5 ± 5.5 mm, which was significantly improved (P <0.01). Two patients had sciatic nerve paralysis after operation, but the symptoms were completely relieved within 6 months and 6 patients had mild claudication. No revision of the prosthesis occurred during follow-up, and no biocompatibility of the material with the host was noted. CONCLUSIONS: Short-term osteotomy and total hip arthroplasty is satisfactory for the treatment of young Crowe type IV hip dysplasia. The intraoperative comprehensive consideration of the degree of soft tissue release and shortening of the osteotomy approach and length can effectively solve the shortening of limbs, Avoid neurovascular injury and improve postoperative hip function.