Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation
Cementless total hip arthroplasty and limb-length equalization in patients with unilateral Crowe type-IV hip dislocation
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DOI：
10.2106/jbjs.d.02097
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发表时间：
2005-02-01
影响因子：
5.3
通讯作者：
Chen, MY
中科院分区：
文献类型：
--
作者：
Lai, KA;Shen, WJ;Chen, MY
背景资料：单侧先天性髋关节高位脱位（Crowe IV型）患者的全髋关节置换术存在许多挑战，包括明显的肢体长度差异问题。本回顾性研究的目的是分析这些患者肢体长度均衡的全髋关节置换术的结果。方法：1988年至1996年，对五十六例单侧Crowe IV型髋关节脱位患者（四十七名女性和九名男性）进行了非骨水泥全髋关节置换术治疗，平均年龄为35.4岁。术前肢体长度差异平均为4.9 cm。在全髋关节置换术前，48例肢体长度差异>4.0 cm的患者使用外固定器进行髂股牵引8 - 17天。将髋臼杯放置在每个患者的解剖位置。结果：6例患者的髂骨固定器销松动。无患者发生针部位感染、髋关节感染或神经麻痹。平均随访147.2个月，Harris髋关节评分平均90.2分。总的来说，全髋关节置换术后平均延长4.6 cm。没有股骨柄翻修。九杯进行了修订，四个是因为聚乙烯磨损和五个因为loosen.Conclusions：我们能够安全地将髋臼杯在解剖位置没有股骨缩短，使股骨头到正常水平术前，因此，我们可以恢复近正常的肢体长度。我们相信，我们的12年结果与无发育不良患者的全髋关节置换术相似。证据等级：治疗级IV。证据等级的完整描述见作者说明。
Background: Total hip arthroplasty in patients with unilateral congenital high dislocation of the hip (Crowe type IV) presents many challenges, including the problem of a marked limb-length discrepancy. The purpose of this retrospective study was to analyze the results of total hip replacement with limb-length equalization in these patients.Methods: From 1988 to 1996, fifty-six patients (forty-seven women and nine men) with unilateral Crowe type-IV dislocation of the hip were treated with a cementless total hip arthroplasty at a mean age of 35.4 years. The preoperative limb-length discrepancy averaged 4.9 cm. Prior to the total hip arthroplasty, forty-eight patients with a limb-length discrepancy of >4.0 cm underwent iliofemoral distraction with use of an external fixator for eight to seventeen days. The acetabular cup was placed in the anatomical position in every patient. Shortening femoral osteotomies were not required.Results: The iliac fixator pins loosened in six patients. No patient had a pin-site infection, hip joint infection, or nerve palsy. At the time of follow-up, at an average of 147.2 months, the Harris hip score averaged 90.2 points. Overall, the mean lengthening after the total hip arthroplasty was 4.6 cm. There were no revisions of the femoral stem. Nine cups were revised, four because of polyethylene wear and five because of loosening.Conclusions: We were able to safely place the acetabular cup at the anatomical position without femoral shortening by bringing the femoral head to the normal level preoperatively; thus, we could restore nearly normal limb length. We believe that our twelve-year results are similar to those of total hip arthroplasty in patients without dysplasia.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.