摘要目的 探讨全髋关节置换术(total hip arthroplasty，THA)治疗成年双侧髋关节发育不良(developmental dysplasia of the hip，DDH)的短期临床疗效。方法 回顾性分析自2012年8月至2016年8月在解放军南京总医院收治的36例双侧DDH的患者，男4例，女32例；年龄29~67岁，平均52.1岁。其中16例患者行一期双侧THA术，另外20例患者行二期THA术。通过病案检索和术后随访评估两组患者的手术时间、住院周期、双侧下肢长度差异以及髋关节Harris评分。结果 所有患者均获得随访，时间18～54个月。一期手术患者住院周期为(11.0±3.3)d，明显短于分期手术的(19.8±5.4)d(t＝－0.4，P＜0.05)；两种手术方案的手术时间、术后双下肢长度差异与Harris评分并无明显差异。末次随访时所有患者与术前相比双侧下肢长度差异明显下降(F＝8.87，P＝0.009)、Harris评分明显提高(F＝0.02，P＝0.006)。结论 THA治疗双侧DDH患者临床效果满意，依据患者情况可选择一期THA术或者二期THA术，两种手术方案对术后髋关节功能恢复并无明显差异。
Abstract：Objective To investigate the short-term clinical efficacy of total hip arthroplasty in the treatment of developmental dysplasia of bilateral hip.Methods A retrospective analysis of 36 patients with bilateral DDH was performed.The patients were admitted to the Nanjing General Hospital from August 2012 to August 2016.There were 4 males and 32 females，with an average age of 52.1 years ranging from 29 to 67 years old.One-stage bilateral THA was performed in 16 patients and secondary THA was performed in the other 20 patients.The operative time，length of hospital stay，difference in length of bilateral lower limbs，and Harris hip scores were assessed by medical record retrieval and postoperative follow-up.Results All patients were followed up for 18 to 54 months.The duration of hospitalization for one-stage operation was(11.0±3.3) days，which was significantly shorter than(19.8±5.4) days for staged surgery(t＝－0.4，P＜0.05).There were no significant differences between the two surgical procedures in terms of operative time，postoperative length of the lower extremities，and Harris scor.All patients had significantly lower bilateral length differences compared with preoperative(F＝8.87，P＝0.009)，Harris score improved significantly(F＝0.02，P＝0.006).Conclusion Total hip arthroplasty is satisfactory in the treatment of bilateral DDH patients，one-stage or second-stage surgery can be selected according to the patient's condition.There is no significant difference between the two surgical procedures for postoperative hip function recovery.
孙祥燚，张雷 *，周利武，赵建宁 *. 全髋关节置换术治疗成年双侧髋关节发育不良的短期疗效[J]. 实用骨科杂志, 2018, 24(8): 687-691.
Sun Xiangyi，Zhang Lei *，Zhou Liwu，et al. The Short-term Efficacy of Total Hip Arthroplasty for Adult Bilateral Dysplasia of the Hip. sygkzz, 2018, 24(8): 687-691.
［1］Ito H，Tanino H，Yamanaka Y，et al.Hybrid total hip arthroplasty using specifically designed stems for patients with developmental dysplasia of the hip.A minimum five-year follow-up study ［J］.Int Orthop，2011，35(9)：1289-1294.
［2］彭伟秋，张祥洪，李富明，等.S-ROM 假体初次全髋关节置换治疗合并股骨近端畸形的髋关节晚期病变 ［J］.实用骨科杂志，2018，24(3)：281-283.
［3］Crowe JF，Mani VJ，Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip ［J］.J Bone Joint Surg( Am)，1979，61(1)：15-23.
［4］Li H，Xu J，Qu X，et al.Comparison of total hip arthroplasty with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation ［J］.J Arthroplasty，2017，32(3)：849-856.
［5］Dandachli W，Kannan V，Richards R，et al.Analysisofcover of thefemoral headi-nnormal and dysplastic hips：new CT-based technique ［J］.J Bone Joint Surg(Br)，2008，90(11)：1428-1434.
［6］Lai KA，Shen WJ，Huang LW，et al.Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-Ⅳ hip dislocation ［J］.J Bone Joint Surg(Am)，2005，87(2)：339-345.
［7］Biant LC，Bruce WJ，Assini JB，et al.Primary total hip arthroplasty in severe developmental dysplasia of the hip.Ten-year results using a cementless modular stem ［J］.J Arthroplasty，2009，24(1)：27-32.
［8］Hasegawa Y，Iwase T，Kanoh T，et al.Total hip arthroplasty for Crowe type Ⅳdevelopmental dysplasia ［J］.J Arthroplasty，2012，27(9)：1629-1635.
［9］Zahar A，Papik K，Lakatos J，et al.Total hip arthroplasty with acetabular reconst-ruction using a bulk autograft for patients with developmental dysplasia of the hip res-ults in high loosening rates at mid-term follow-up［J］.Int Orthop，2014，38(5)：947-951.
［10］Bicanic G，Barbaric K，Bohacek I，et al.Current concept in dysplastic hip arth-roplasty：Techniques for acetabular and femoral reconstruction［J］.World J Orthop，2014，5(4)：412-424.
［11］Seagrave KG，Troelsen A，Malchau H，et al.Acetabular cup position and risk of dislocation inprimary total hip artbroplasty［J］.Acta Orthop，2017，88(1)：10-17.
［12］Kim YH，Kim JS.Total hip arthroplasty in adult patients who had developme-ntal dysplasia of the hip［J］.J Arthroplasty，2005，20(8)：1029-1036.
［13］Li H，Wang L，Dai K，et al.Autogenous impaction grafting in total hip arthro-plasty with developmental dysplasia of the hip［J］.J Arthroplasty，2013，28(4)：637-643.
［14］刘长路，刘晓民，刘万林，等.全髋置换术治疗髋关节发育不良并骨关节炎［J］.实用骨科杂志，2014，20(6)：551-553.
［15］Oinuma K，Tamaki T，Miura Y，et al.Total hip arthroplasty with subtrochanteric shortening osteotomy for Crowe grade 4 dysplasia using the direct anterior approach ［J］.J Arthroplasty，2014，29(3)：626-629.
［16］Garland A，Rolfson O，Garellick G，et al.Early postoperative mortality after simultaneous or staged bilateralprimary total hip arthroplasty：an observational register study from the Swedish Hip Arthroplasty Register［J］.BMC Musculoskelet Disord，2015，9(16)：77.
［17］项鹏，余斌，熊军，等.双侧髋关节同期与分期置换临床疗效与安全性的Meta分析［J］.中国矫形外科杂志，2012，20(4)：289-294.
晋公网安备 14010702070875号