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Title: [Effectiveness of autologous femoral head bone graft in total hip arthroplasty for Crowe type Ⅲ developmental dysplasia of hip with acetabular bone defect].
Author: Yin S, Zhong H, Li R, Mou P, Yang J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2018 Jan 15; 32(1):20-24. PubMed ID: 29806359.
Abstract:
OBJECTIVE: To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect. METHODS: Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41.08±7.90. The preoperative leg length discrepancy was 0.53-4.28 cm, with an average of 2.47 cm. Autologous femoral head bone graft and cancellous screw fixation were used in all cases to reconstruct acetabula in THA. Four cases were performed with subtrochanteric shortening osteotomy at the same time. RESULTS: All incisions healed by first intention. Twelve cases were followed up 1 year and 10 months to 5 years, with an average of 3.0 years. X-ray films showed that bone healing was observed in all cases at 6 months to 1 year after operation. There was no bone graft osteolysis, absorption, bone graft collapse, and acetabular prosthesis loosening. At last follow-up, the Harris score was 89.50±2.78, showing significant difference when compared with preoperative value ( t=-25.743, P=0.003). The length discrepancy was 0-1.81 cm at last follow-up with an average of 0.76 cm. CONCLUSION: Autologous femoral head bone graft is effective for Crowe type Ⅲ DDH with acetabular bone defect, which has advantages of restoring pelvic bone stock, obtaining satisfied prosthetic stability and mid-term effectiveness. 目的: 探讨 Crowe Ⅲ型髋关节发育不良人工全髋关节置换术（total hip arthroplasty，THA）中，采用自体股骨头结构植骨重建髋臼的手术技巧及疗效。. 方法: 回顾性分析 2012 年 7 月—2015 年 9 月收治的 12 例（12 髋）Crowe Ⅲ型髋关节发育不良患者临床资料。其中，男 2 例，女 10 例；年龄 37～75 岁，平均 54.3 岁。主要临床症状为髋关节疼痛伴不同程度活动受限。术前髋关节功能 Harris 评分为（41.08±7.90）分。双下肢不等长 0.53～4.28 cm，平均 2.47 cm。THA 术中采用自体股骨头结构植骨松质骨螺钉固定重建髋臼，其中 4 例同时行转子下短缩截骨矫形。. 结果: 术后切口均Ⅰ期愈合。12 例均获随访，随访时间 1 年 10 个月～5 年，平均 3.0 年。X 线片复查示，自体股骨头与髋臼骨床均于术后 6 个月～1 年达骨性愈合；末次随访时，髋臼假体位置良好，假体周围未见透亮线，植骨块未发生骨吸收及塌陷。术后患者髋关节疼痛症状明显改善或消失，步态正常。末次随访时，Harris 评分为（89.50±2.78）分，与术前比较差异有统计学意义（ t=–25.743， P=0.003）。双下肢不等长 0～1.81 cm，平均 0.76 cm。. 结论: 对于 Crowe Ⅲ型髋关节发育不良臼顶存在骨缺损患者，THA 术中通过自体股骨头结构植骨重建髋臼能最大程度恢复骨量，获得良好髋臼假体稳定及中期疗效。.

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