背景:发育性髋关节发育不良(DDH)是继发性髋关节骨关节炎的主要原因之一,引起相当大的痛苦,行动不便,生活质量下降。管理患有CroweIV型DDH的个体的最佳方法仍然存在争议。本研究旨在回顾现有的关于全髋关节置换术(THA)作为CroweIV型DDH治疗方式的应用。评估其疗效在解决这种严重的髋关节畸形。
方法:整个PubMed的全面搜索,Scopus,和WebofScience数据库确定了相关研究。纳入标准包括报告CroweIV型DDH患者THA结果的调查。数据提取和质量评估由两名审阅者独立进行。利用R软件,通过比例分析分析THA并发症的发生率,采用逆方差法。
结果:在本系统综述中,共纳入74项研究,包括2,829例(3,356髋)诊断为CroweIV型DDH的患者的总体样本量。后/后外侧入路是最常用的手术入路,其次是横向硬化和直接横向进近。大多数研究采用转子下截骨术。值得注意的是,Post-THA,腿长差异(LLD)减小,特伦登堡标志解决了,背部疼痛减轻。患者报告的结果指标,如Harris髋关节评分(HHS)显着改善。还评估了主要术后并发症的合并患病率,包括位错(7.2%),修订(8.7%),术中骨折(10.5%),松动(5.7%),神经麻痹(5.6%),深静脉血栓形成(3.6%),感染(3.8%),异位骨化2级及以上(6.1%),复杂患者率为11.0%。
结论:综合不同的研究数据,THA的性能概述浮出水面,展示了功能的显著增强,减轻疼痛,生活质量,以及大幅LLD的修正。虽然THA显示出积极的结果,已经报道了并发症的实例。接受THA的决定应涉及外科医生和患者之间的协作评估,考虑潜在的益处和并发症。
BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the principal causes of secondary hip osteoarthritis, giving rise to considerable pain, impaired mobility, and a reduced quality of life. The optimal approach to managing individuals who have Crowe type IV DDH remains controversial. This study aimed to
review the existing literature on the application of total hip arthroplasty (THA) as a treatment modality for Crowe type IV DDH, assessing its efficacy in addressing this severe hip deformity.
METHODS: A comprehensive search across the PubMed, Scopus, and Web of Science databases identified relevant studies. Inclusion criteria encompassed investigations reporting outcomes of THA in Crowe type IV DDH patients. Data extraction and quality assessment were performed independently by 2 reviewers. Utilizing R software, the prevalence of THA complications was analyzed through proportion analysis, employing the inverse variance method.
RESULTS: In this systematic
review, a total of 74 studies were included, comprising a collective sample size of 2,829 patients (3,356 hips) diagnosed with Crowe type IV DDH. The posterior or posterolateral approach was the most commonly utilized surgical approach, followed by the lateral Hardinge and direct lateral approaches. The majority of studies have employed subtrochanteric osteotomies. Notably, post-THA, leg length discrepancy decreased, Trendelenburg sign resolved, and back pain was reduced. Patient-reported outcome measures like the Harris Hip Score improved significantly. The pooled prevalence rates of major postoperative complications were also assessed, including dislocation (7.2%), revision (8.7%), intraoperative fractures (10.5%), loosening (5.7%), nerve paralysis (5.6%), deep vein thrombosis (3.6%), infection (3.8%), heterotopic ossification grade 2 and above (6.1%), and a complicated patient rate of 11.0%.
CONCLUSIONS: Synthesizing diverse study data, an overview of THAs performance emerges, demonstrating significant enhancements in function, pain reduction, quality of life, and the correction of substantial leg length discrepancy. While THA has shown positive outcomes, instances of complications have been reported. The decision to undergo THA should involve a collaborative assessment between the surgeon and the patient, considering potential benefits and complications.