成人高位髋脱位一期全髋置换术

One- stage total hip arthroplasty for high- displacement dislocation of the hip in adult

摘要:

[目的] 探讨三种不同病因成人高位髋脱位行一期全髋置换治疗手术策略和疗效。[方法] 2017 年 5 月—2021 年 3 月，对 13 例(17 髋)不同病因成人高位髋脱位采用全髋置换术治疗，包括 7 例(11 髋)为发育性髋脱位2 例为化脓性髋关节后遗髋骨关节病4 例为陈旧性髋关节后脱位。[结果]所有患者均顺利完成手术，手术伤口均一期愈合，无感染，深静脉血栓发生;术后短暂性股神经麻痹 1 例;术后脱位 2 例。随访时间平均(33.1±15.6)个月，与术前相比，末次随访患者 VAS 评分显著减少(P＜0.05)，髋屈-伸 ROM，髋内-外旋 ROM 及 Harris 评分显著增加(P＜0.05)。影像方面，粗隆下截骨愈合时间为 4~8 个月。末次随访时，双下肢不等长及纵向旋转中心和水平旋转中心均较术前显著改善(P＜0.05)，无假体松动者。[结论]成人高位髋脱位行 THA 治疗早中期疗效满意。

Abstract:

[Objective] To explore the clinical outcomes of one-stage total hip arthroplasty (THA) for high-displacement dislocation of the hip in adults. [Methods] From May 2017 to March 2021, 13 patients (17 hips) underwent THA in our department for high-displacement dislocation of the hip due to congenital dislocation of the hip in 7 cases (11 hips) , previous pyogenic hip osteoarthropathy in 2 cases, and un- reduced traumatic posterior dislocation of the hip in 4 cases. [Results] All patients had THA performed successfully with well incision heal- ing without infection and deep vein thrombosis, despite of the fact that temporary femoral nerve palsy in 1 case and re-dislocation in 2 cases were found, which were treated correspondingly without serious consequences. At the latest follow up lasted for (33.1±15.6) month the VAS score for pain significantly decreased (P＜0.05) , while the hip flexion-extension range of motion (ROM) , external-internal rotation ROM and Harris score significantly increased compared with those preoperatively (P＜0.05) . In term of radiographic evaluation, the leg length discrep- ancy and position of rotate centers significantly improved at the latest follow up compared with those preoperatively (P＜0.05) , with osteoto- my healed from 4 to 8 months postoperatively. [Conclusion] The one-stage THA used for high-displacement dislocation of the hip does achieve satisfactory mid-term clinical outcomes.