摘要发育性髋关节发育不良是一种常见病,不同国家、种族发病情况不同,Kumar等报道,丹麦的发病率为5.4%~12.8%,韩国为1.8%,土耳其为2.4%,新加坡为7.3%。发育性髋关节发育不良发病原因是多方面的,包括遗传和宫内环境因素,危险因素包括女性、第一胎、家族遗传病史、臀位分娩、羊水过少、斜颈、下肢畸形等。许多国家对新生儿进行筛查,但存在漏诊病例,即使确诊病例也因年幼时治疗不及时或治疗不当,导致成年时继发骨关节炎、高度脱位、骨骼发育畸形、髋部软组织畸形等病理改变。以往治疗的主要方法是髋部截骨术,但大部分患者最终因疗效欠佳要实施全髋关节置换术。轻度的成人发育性髋关节发育不良可应用标准的全髋置换技术治疗,重度患者使外科技术面临挑战。随着关节置换外科技术进步,假体不断改良,使患者术后获得了持久良好功能。
对Crowe Ⅰ、Ⅱ、Ⅲ型患者实施全髋关节置换术,手术过程与普通的初次全髋关节置换术相差不大,操作不是很复杂。而对Crowe Ⅳ型患者,20世纪90年代开始国外医生在为髋关节高脱位患者行全髋关节置换时开始尝试转子下股骨短缩截骨。十多年来,髋臼重建的方式和股骨短缩截骨的方式被不断改进,并取得满意临床疗效。髋关节发育不良(developmental dysplasia of the hip,DDH)患者较原发性髋关节骨关节炎患者骨盆更加前倾,导致其脊柱前倾,髋、膝关节屈曲。DDH患者的这些矢状面形态在行全髋关节置换术时需要加以考虑。丛锐军等研究认为,Crowe Ⅳ型患者因长期负重不平衡导致骨盆倾斜,继发性腰椎侧凸,使双侧代偿后肢体长度差与实际肢体长度差存在差异,恢复肢体绝对长度后大部分患者感觉患肢过长,短期训练后肢体延长感不能恢复,然而通过股骨短缩截骨恢复肢体代偿长度可获得满意效果。综上所述,解剖中心髋臼重建、股骨转子下短缩截骨全髋置换术治疗Crowe Ⅳ型成人发育性髋关节发育不良可获得满意疗效。
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