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Title: [Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip].
Author: Tang L, Chen M, Li G, Luo Z, Ji X, Zhang X, Wu K, Zhu C, Shang X.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Jun 15; 34(6):683-688. PubMed ID: 32538556.
Abstract:
OBJECTIVE: To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH). METHODS: Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value. RESULTS: The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly ( t=-22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed. CONCLUSION: The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur. 目的: 探讨股骨近端重建联合人工全髋关节置换术（total hip arthroplasty，THA）治疗成人 Crowe Ⅳ 型先天性髋关节发育不良（developmental dysplasia of the hip，DDH）的早期临床疗效。. 方法: 2015 年 5 月—2018 年 3 月，采用股骨近端重建技术联合 THA 治疗 29 例（33 髋）Crowe Ⅳ 型 DDH 患者，其中男 6 例（7 髋），女 23 例（26 髋）；年龄 24～74 岁，平均 44.9 岁。术前髋关节 Harris 评分为（44.0±12.0）分；33 髋均有步态异常，Trendelenburg 征阳性；双下肢不等长，相差（3.8±1.6）cm。术前 X 线片及 CT 提示患髋呈完全脱位状态且大粗隆严重上移，股骨颈发育异常，前倾角及颈干角异常，股骨近端髓腔发育异常。记录患者手术时间、术中出血量、输血率及并发症发生情况；于 X 线片上采用 Gruen 和 DeLee-Charnley 分区方法评估假体无菌性松动情况；采用 Harris 评分评估髋关节功能，计算双下肢长度差，并与术前比较。. 结果: 患者手术时间 80～240 min，平均 124.8 min；术中出血量 165～1 300 mL，平均 568.4 mL；17 例（51.5%）给予输血治疗。术后切口均Ⅰ期愈合，无感染及下肢深静脉血栓形成等发生。29 例均获随访，随访时间 19～53 个月，平均 33 个月。1 例术后 4 周坠床后患髋后脱位，给予手法复位外展支具固定 4 周，随访 12 个月未再次脱位。2 例患者术后出现患肢坐骨神经麻痹，给予甲钴胺治疗，12 周后完全康复。术后 3 例 Trendelenburg 征阳性，4 例轻度跛行。X 线片示术后 3～6 个月截骨区均骨性愈合，随访期间无钢丝断裂发生。末次随访时，髋关节 Harris 评分为（89.8±2.8）分，双下肢长度差为（0.6±0.4）cm，均较术前显著改善（ t=−22.917， P=0.000； t=11.958， P=0.000）。2 例患者股骨假体周围 Gruen 1、7 区呈局限性骨溶解，但未见松动下沉征象。股骨及髋臼假体均无明显松动移位表现，均获良好骨长入。. 结论: 使用股骨近端重建技术联合 THA 治疗 Crowe Ⅳ 型 DDH，术后早期疗效满意。股骨近端重建技术能有效恢复接近标准的股骨近端解剖结构，是处理股骨近端畸形的有效方法之一。.

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