摘要【目的】观察全髋关节置换术治疗髋关节发育不良（DD H ）并骨性关节炎患者的临床疗效。【方法】2008年8月至2012年12月收治DDH并骨性关节炎患者12例12髋；CroweⅠ型2例，CroweⅡ型2例，CroweⅢ型1例，CroweⅣ型7例。术前Harris评分（46．8±15．2）分，肢体短缩平均4．5（3～6．5）cm。采用后外侧入路，行非股骨短缩截骨的全髋关节置换术，其中5例5髋行自体股骨头植骨重建髋臼。【结果】所有患者均获得随访，随访时间平均28（12～67）个月。术中有1例患者股骨近端发生劈裂，术中钢丝捆扎；此例患者12个月随访时骨折均愈合。末次随访时所有患者无假体松动。5例患者行髋臼自体骨植骨，术后12个月复查时植骨块无吸收，植骨块与植骨床融合。1例患者（延长＞4 cm ）术后出现小腿皮肤麻木，1个月后恢复。所有患者无关节脱位、感染、异位骨化及深静脉栓塞等并发症发生。末次随访 Harris评分（85．48±9．67）分，与术前比较差异有统计学意义（ t ＝4．52， P＜0．05）。【结论】对于伴有骨性关节炎的DD H 患者初次行髋关节置换术，术前进行精确测量与评估，术中彻底松解软组织，正确处理髋臼和股骨，术后近期临床疗效良好。
Abstract：Objective To observe the clinical efficacy of total hip arthroplasty(THA) for the treatment of osteoarthritis secondary to developmental dysplasia of the hip (DDH) .[Methods]A total of 12 patients(12 hips) with osteoarthritis secondary to DDH from Aug .2008 to Dec .2012 included 2 patients with Crowe typeⅠ ,2 patients with Crowe type Ⅱ ,1 patient with Crowe type Ⅲ and 7 patients with Crowe type Ⅳ .Preopera-tive Harris score was 46 .8 ± 15 .2 ,and average limb shortening was 4 .5cm(3~6 .5cm) .All patients under-went total hip arthroplasty of non-femoral shortening osteotomy .Among them ,5 patients(5 hips) underwent femoral head autograft and acetabular reconstruction .[Results]All patients were followed up for the average 28 (12~67) months .One patient with proximal femoral split during the operation had bony healing by steel wire bundling during the operation at 12 months of follow up .No prosthesis loosening was found in all patients at the final follow up .Five patients underwent acetabular autograft and had no absorption of the grafted bone block by reexamination 12 months after operation ,and the grafted bone block was fused with the grafted bone bed .One patient(lengthening for more than 4cm) with numbness in lateral leg after operation recovered after 1 month .No complications such as joint dislocation ,infection ,ectopic ossification and deep venous embolism oc-curred in all patients .Harris score was (85 .48 ± 9 .67) at the final follow up ,and there was significant differ-ence between the final follow up and before operation( t=4 .52 ,P<0 .05) .[Conclusion]For patients with os-teoarthritis secondary to DDH ,precise measurement and evaluation before the operation ,complete soft tissue lysis during operation and correct management of acetabulum and femur can obtain good short-term clinical ef-f icacy .
2014, Vol. 31 
