目的:探讨高髋关节中心技术全髋关节置换术(THA)治疗CroweⅡ、Ⅲ型发育性髋关节发育不良(DDH)和严重髋关节骨性关节炎(HOA)的临床疗效。
方法:2018年1月至2020年1月共收治CroweⅡ、Ⅲ型DDH合并重度HOA患者74例。以解剖型髋关节中心重建术37例作为对照组,包括7名男性和30名女性,年龄42~65岁,平均(58.40±4.98)岁,体重指数(BMI)18~29kg·m-2,平均(23.02±2.21)kg·m-2。37例常规高髋关节中心技术重建术作为研究组,包括5名男性和32名女性,年龄41~65岁,平均(57.31±5.42)岁,BMI范围为18~29kg·m-2,平均(23.14±2.07)kg·m-2。患者出现髋部疼痛,有限的功能和运动范围,手术前步态不稳定。所有患者都接受了THA,对照组进行术中解剖髋关节中心重建,研究组行术中高位髋关节重建术。比较两组患者的围手术期指标。髋关节功能,术前评估患者的平衡功能和步态,3个月,6个月,手术后12个月.双下肢的长度差,旋转中心的水平距离,术前和术后1年测量旋转中心垂直距离和股骨偏心距。统计两组患者术中并发症发生率及术后随访情况。
结果:研究组手术时间短于对照组,术中出血量少于对照组(P<0.05)。经过12个月的随访,研究组随访1例,对照组随访2例。Harris评分和Berg平衡量表(BBS),步速,研究组术后3个月和6个月的步频和单步长高于对照组(P<0.05);两组术后12个月的指标比较差异无统计学意义(P>0.05)。研究组术后12个月旋转中心垂直距离大于对照组(P<0.05)。下肢的长度差异没有显着差异,旋转中心的水平距离,两组股骨偏心距比较差异无统计学意义(P>0.05)。两组均无并发症发生。
结论:THA对DDH和严重HOA患者的长期影响在两种中央髋关节重建方法之间相似,安全性很好,高髋中央重建技术可缩短手术时间,减少术中出血量。同时,在早期恢复髋关节功能方面有一定的优势,患者的平衡功能和步行功能。
OBJECTIVE: To explore the clinical efficacy of high hip center technique total hip arthroplasty (THA) for Crowe Ⅱand Ⅲ developmental dysplasia of hip (DDH) and severe hip osteoarthritis (HOA).
METHODS: From January 2018 to January 2020, 74 patients with Crowe typeⅡand Ⅲ DDH and severe HOA were admitted, and 37 cases of anatomical hip center reconstruction were taken as control group, including 7 males and 30 females, aged from 42 to 65 years old with an average of (58.40±4.98) years old, body mass index (BMI) ranged from 18 to 29 kg·m-2 with an average of (23.02±2.21) kg·m-2. Thirty-seven routine high hip center technical reconstruction were performed as study group, including 5 males and 32 females, aged from 41 to 65 years old with an average of (57.31±5.42) years old, BMI ranged from 18 to 29 kg·m-2 with an average of (23.14±2.07) kg·m-2. The patients presented with hip pain, limited function and range of motion, and gait instability before surgery. All patients underwent THA, the control group underwent intraoperative anatomical hip center reconstruction, and the study group underwent intraoperative high hip joint reconstruction. The perioperative indicators of the two groups were compared. The hip joint function, balance function and gait of the patients were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The length difference of both lower limbs, horizontal distance of rotation center, vertical distance of rotation center and femoral eccentricity were measured before operation and 1 year after operation. The incidence of complications in the two groups during the operation and postoperative follow-up was counted.
RESULTS: The operation time of the study group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group (P<0.05). After 12-months follow-up, 1 was lost to followvup in study group and 2 were lost to follow-up in control group. The Harris scores and Berg balance scale(BBS), pace, stride frequency and single step length in the study group were higher than those in the control group at 3 months and 6 months after operation (P<0.05);there was no statistically significant difference between the two groups in the indexes 12 months after operation (P>0.05). The vertical distance of the center of rotation of the study group was greater than that of the control group 12 months after operation (P<0.05), and there was no significant difference in the length difference of the lower limbs, the horizontal distance of the center of rotation, and the femoral eccentricity between two groups (P>0.05). There were no complications in either group.
CONCLUSIONS: The long-term effects of THA in patients with DDH and severe HOA were similar between the two central hip reconstruction methods, and the safety was good, and the high hip central reconstruction technique could shorten the operation time and reduce the amount of intraoperative blood loss.At the same time, it has certain advantages in early recovery of hip joint function, balance function and walking function of patients.