Objective: To evaluate the effectiveness of total hip arthroplasty (THA) combined with subtrochanteric osteotomy in the treatment of Crowe type Ⅳdevelopmental dysplasia of the hip (DDH).
Methods: Between April 2008 and June 2016, 71 patients with unilateral Crowe type Ⅳ DDH were treated with THA. Of 71 cases, 44 were performed with subtrochanteric osteotomy (osteotomy group) and 27 were performed without subtrochanteric osteotomy (non-osteotomy group). There was no significant difference in gender, age, body mass, height, body mass index, affected side, and preoperative Harris score between 2 groups ( P>0.05). The complications were recorded and the effectiveness was assessed by Harris score. Besides, the femoral dislocation height and the settling depth of sleeve were measured in the pelvic anteroposterior X-ray film pre- and post-operatively.
Results: Osteotomy group was followed up 12-90 months (mean. 34.77 months), and non-osteotomy group was followed up 12-79 months (mean, 34.33 months). There was no significant difference in follow-up time between 2 groups ( t=-0.088, P=0.930). There was 11 cases of intraoperative or postoperative complications in osteotomy group, and 3 cases of postoperative complications in non-osteotomy group. Among the osteotomy group, 1 case had nonunion due to infection and received revision after 20 months. No loosening or dislocation of the implant occurred in both 2 groups. Significant differences were found in femoral dislocation height and settling depth of sleeve between 2 groups ( t=-8.452, P=0.000; t=6.783, P=0.000). Moreover，the osteotomy length was not correlated with the settling depth of sleeve ( r=-0.038, P=0.806). At last follow-up, there was no significant difference in Harris score between 2 groups ( t=-1.160, P=0.254).
Conclusion: THA combined with subtrochanteric osteotomy can provide a favorable outcome for treating Crowe type Ⅳ DDH. Furthermore, patients with higher femoral dislocation and severely narrow femoral proximal canals are prone to be peformed with subtrochanteric osteotomy.
目的: 探讨 Crowe Ⅳ型髋关节发育不良（developmental dysplasia of the hip，DDH）人工全髋关节置换术（total hip arthroplasty，THA）术中应用粗隆下截骨的临床效果。.
方法: 回顾分析 2008 年 4 月—2016 年 6 月采用 THA 治疗的 71 例单侧 Crowe Ⅳ型 DDH 患者临床资料，其中 44 例术中行粗隆下截骨（截骨组），27 例未行粗隆下截骨（未截骨组）。两组患者性别、年龄、体质量、身高、体质量指数、侧别以及术前 Harris 评分等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术相关并发症发生情况，采用 Harris 评分评价髋关节功能。于手术前后摄骨盆正位 X 线片，测量术前股骨脱位高度和术后 SROM 近端假体植入深度。.
结果: 截骨组随访时间 12～90 个月，平均 34.77 个月；未截骨组为 12～79 个月，平均 34.33 个月；两组比较差异无统计学意义（ t=–0.088， P=0.930）。截骨组术中及术后共 11 例发生并发症，其中 1 例因感染致截骨处不愈合，于术后 20 个月行翻修手术；未截骨组术后 3 例发生并发症。两组患者假体位置良好、无松动，无关节脱位。两组术前股骨脱位高度及 SROM 近端假体植入深度比较差异均有统计学意义（ t=–8.452， P=0.000； t=6.783， P=0.000）；截骨组患者 SROM 近端假体植入深度与截骨长度无相关（ r=–0.038， P=0.806）。末次随访时，截骨组及未截骨组 Harris 评分比较差异无统计学意义（ t=–1.160， P=0.254）。.
结论: Crowe Ⅳ型 DDH 患者 THA 术中应用粗隆下截骨可以获得良好的临床效果，术前股骨脱位较高和股骨近端髓腔严重狭窄的患者更倾向于术中行粗隆下截骨。.
Keywords: Crowe classification; Total hip arthroplasty; developmental dysplasia of the hip; subtrochanteric osteotomy.