本文關(guān)鍵詞：改良轉(zhuǎn)子間截骨術(shù)聯(lián)合全髖關(guān)節(jié)置換治療重度髖關(guān)節(jié)發(fā)育不良　出處：《山東大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 股骨短縮截骨 髖關(guān)節(jié)復(fù)位 全髖關(guān)節(jié)置換術(shù) 發(fā)育性髖關(guān)節(jié)發(fā)育不良

【摘要】：背景對(duì)于發(fā)育性髖關(guān)節(jié)發(fā)育不良(developmental dysplasia of hip, DDH),人工全髖關(guān)節(jié)置換術(shù)(THA)是行之有效的治療方法,可以有效改善關(guān)節(jié)功能并緩解疼痛癥狀。但是對(duì)于重度DDH患者(達(dá)到C rowe Ⅳ型標(biāo)準(zhǔn))進(jìn)行THA治療將會(huì)是技術(shù)上的挑戰(zhàn)。為使此類患者在術(shù)后獲得最為滿意的結(jié)果,需要保證的一個(gè)重要前提是在術(shù)中將髖關(guān)節(jié)旋轉(zhuǎn)中心解剖學(xué)復(fù)位。髖關(guān)節(jié)的復(fù)位需要對(duì)股骨進(jìn)行短縮截骨,以最大程度地降低由于下肢延長(zhǎng)牽拉神經(jīng)血管而致其損傷的風(fēng)險(xiǎn)�，F(xiàn)行的幾種常用的股骨短縮方式,包括階梯形(step-cut)截骨術(shù)及chevron截骨術(shù)等,療效確切,但術(shù)中操作較為精密復(fù)雜,需要外科醫(yī)生具備精湛技藝,且有創(chuàng)傷大、手術(shù)時(shí)間過長(zhǎng)及伴隨而來的高感染風(fēng)險(xiǎn),術(shù)后骨不愈合率較高。因此在對(duì)重度DDH患者行THA治療過程中,尋找一種相對(duì)創(chuàng)傷小、預(yù)后良好且并發(fā)癥少的股骨截骨技術(shù),有益于患者術(shù)后康復(fù)及醫(yī)療資源的有效利用。目的本文描述在對(duì)Crowe Ⅳ型DDH患者進(jìn)行全髖關(guān)節(jié)置換的過程中,正確重建髖臼后,采用Paavilainen提出的轉(zhuǎn)子間截骨技術(shù)并將其改良后,進(jìn)行短縮股骨以協(xié)助復(fù)位髖關(guān)節(jié),同時(shí)對(duì)這一技術(shù)的療效和預(yù)后進(jìn)行評(píng)價(jià)。方法回顧性分析2009年1月至2015年12月,由山東大學(xué)齊魯醫(yī)院骨一科收治的因重度DDH而進(jìn)行轉(zhuǎn)子間截骨聯(lián)合THA的患者19例(21髖),其中男性4例,女性15例,男性及女性患者中各有有1例累及雙側(cè)髖關(guān)節(jié)。脫位原因?yàn)榘l(fā)育不良者15例,幼年時(shí)期髖關(guān)節(jié)感染者4例。平均年齡48.5(29-66)歲。術(shù)前和術(shù)后第6、12個(gè)月及隨訪結(jié)束時(shí)分別記錄髖關(guān)節(jié)功能評(píng)分(髖關(guān)節(jié)Harris評(píng)分)。于術(shù)前、術(shù)后第2天及隨訪第12個(gè)月時(shí)拍攝骨盆前后正位、髖關(guān)節(jié)正側(cè)位X線片進(jìn)行動(dòng)態(tài)比對(duì),需要進(jìn)行觀察的指標(biāo)有：骨愈合情況、假體周緣透亮線、股骨假體位置及沉降、髖臼假體位移及角度變化。記錄手術(shù)前及手術(shù)后雙下肢長(zhǎng)度偏差(leg length discrepancy, LLD)和術(shù)后神經(jīng)血管并發(fā)癥。結(jié)果19名患者均獲得隨訪,平均隨訪時(shí)間31(7-69)個(gè)月。在隨訪期間所有患者訴疼痛明顯緩解及關(guān)節(jié)功能顯著提升。髖關(guān)節(jié)Harris評(píng)分從術(shù)前的平均55.0(28-61)分,顯著提高到術(shù)后12個(gè)月的88.4(79-94；P0.01)分。末次隨訪時(shí)X線檢查沒有發(fā)現(xiàn)感染、脫位及假體松動(dòng)的病例,所有患者截骨處骨皮質(zhì)均顯示愈合征象,平均愈合時(shí)間為3.3(3-6)個(gè)月。17例單側(cè)髖關(guān)節(jié)脫位患者中,有15例在術(shù)后第12個(gè)月獲得隨訪,其術(shù)前雙下肢長(zhǎng)度平均偏差53.9(23～76)mm；術(shù)后即刻測(cè)量的雙下肢長(zhǎng)度偏差平均9.5(4-23)mm；術(shù)后12個(gè)月偏差小于10 mm者11例,介于10-20 mm者3例,超過20mm者1例,平均6.9(0-21)mm。在隨訪期間所有病例沒有出現(xiàn)明顯的坐骨神經(jīng)麻痹癥狀。結(jié)論改良后的Paavilainen轉(zhuǎn)子間截骨技術(shù)聯(lián)合THA治療Crowe Ⅳ 型DDH,能獲得滿意的短期療效,長(zhǎng)期預(yù)后有待進(jìn)一步的觀察。這項(xiàng)截骨技術(shù)具有相對(duì)創(chuàng)傷小、操作較簡(jiǎn)便及并發(fā)癥少等優(yōu)勢(shì),值得在關(guān)節(jié)領(lǐng)域的外科醫(yī)生關(guān)注和進(jìn)一步完善。
[Abstract]:Background for developmental dysplasia of hip (DDH), total hip arthroplasty (THA) is an effective treatment method, which can effectively improve joint function and relieve pain symptoms. But for severe DDH patients (reaching the C Rowe IV standard), THA treatment will be a technical challenge. An important prerequisite for ensuring the most satisfactory results of such patients after surgery is the anatomical reduction of the rotation center of the hip joint. The reduction of the hip requires a short osteotomy of the femur to minimize the risk of injury due to prolonged stretch of the lower extremities. Several common femoral shortening current, including ladder shaped (step-cut) effect of osteotomy and chevron osteotomy, exactly, but the operation is more sophisticated, need to have the surgeon virtuosity, and trauma, long operation time and with high risk of infection and postoperative bone nonunion rate. Therefore, in the process of THA treatment for severe DDH patients, we need to find a relatively less invasive, good prognosis and less complications of femoral osteotomy technology, which is beneficial for postoperative rehabilitation and effective utilization of medical resources. The purpose of this paper is described in the process of total hip replacement in Crowe IV DDH patients, the correct acetabular reconstruction, the proposed inter rotor Paavilainen osteotomy technology and its improvement, by shortening the femur to assist in reduction of hip joint, and the curative effect and prognosis of this technique is evaluated. Methods a retrospective analysis from January 2009 to December 2015, from Qilu Hospital of Shandong University Department of orthopaedics were due to severe DDH and 19 cases of intertrochanteric osteotomy combined with THA patients (21 hips), of which 4 were male, 15 cases of female, male and female patients in the 1 patients with bilateral hip joint. The causes of dislocation were 15 dysplasia, and 4 cases of hip joint infection at young age. The average age was 48.5 (29-66) years. The hip joint function score (Harris score) was recorded before and sixth, twelfth months after the operation and at the end of the follow-up. Preoperatively, second days and twelfth months follow-up after shooting pelvic anteroposterior, hip joint X-ray dynamic alignment, require observation indicators are:, peripheral prosthesis and femoral prosthesis radiolucent line position and settlement, displacement and angle of acetabular prosthesis in bone healing. Double leg length deviation (leg length discrepancy, LLD) and postoperative neurovascular complications were recorded before and after operation. Results all the 19 patients were followed up and the average follow-up time was 31 (7-69) months. During the follow-up period, all patients complained of significant pain relief and significantly improved joint function. The Harris score of the hip joint was 55 (28-61) scores from the preoperative, which was significantly increased to 88.4 (79-94; P0.01) scores at 12 months after the operation. No signs of infection, dislocation and prosthesis loosening were found in X-ray examination at the last follow-up. Bone healing in all the osteotomy sites showed an average healing time of 3.3 (3-6) months. 17 cases of patients with unilateral hip dislocation, 15 cases after twelfth months follow-up, the preoperative limb length average deviation 53.9 (23 ~ 76) mm; postoperative limb length deviation immediately measured average 9.5 (4-23) mm; 11 cases 12 months after the operation deviation is less than 10 mm in 3 cases, between 10-20 mm, 1 cases of more than 20mm, an average of 6.9 (0-21) mm. There was no obvious symptom of sciatic nerve paralysis in all cases during the follow-up period. Conclusion modified Paavilainen intertrochanteric osteotomy combined with THA in the treatment of Crowe type IV DDH can achieve satisfactory short-term effect, and long-term prognosis needs further observation. This osteotomy technique has the advantages of small relative trauma, simple operation and less complications, which should be paid attention to and further improved by surgeons in the field of joint.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.4

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 周錫華，彭明惺，周素華，劉利君;先天性髖關(guān)節(jié)脫位髖骨截骨術(shù)后再脫位的原因和處理[J];華西醫(yī)學(xué);1996年01期

2 宋軍川,李國(guó)勝,李俊,丁雷;脛骨高位截骨術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎50例報(bào)告[J];中醫(yī)正骨;2000年04期

3 孫明舉,王巖,王松濤,汪偉;截骨術(shù)的一點(diǎn)改進(jìn)[J];解放軍醫(yī)學(xué)雜志;2001年06期

4 隋強(qiáng),王立勝,趙杰林,張連有;聯(lián)合截骨術(shù)治療大齡兒童先天性髖關(guān)節(jié)脫位[J];實(shí)用骨科雜志;2001年03期

5 金群華,陳志榮,施建黨,王揚(yáng)生,田豐年,王軍;脛骨高位截骨術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎[J];寧夏醫(yī)學(xué)院學(xué)報(bào);2001年01期

6 黃德勇;脛骨高位截骨術(shù)已過時(shí)了嗎[J];國(guó)外醫(yī)學(xué)(骨科學(xué)分冊(cè));2002年03期

7 張作峰,王獻(xiàn)印,丁敬沛,韓文朝;脛骨高位截骨術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎[J];中醫(yī)正骨;2003年04期

8 魯木,劉立偉;髖聯(lián)合截骨術(shù)一次性重建關(guān)節(jié)結(jié)構(gòu)治療嚴(yán)重先天性髖關(guān)節(jié)脫位[J];臨床骨科雜志;2004年02期

9 王冠軍;張作峰;王獻(xiàn)印;韓文朝;;脛骨高位截骨術(shù)治療膝關(guān)節(jié)骨性關(guān)節(jié)炎32例[J];河南外科學(xué)雜志;2007年02期

10 張功林;章鳴;;脛骨高位截骨術(shù)[J];中國(guó)骨傷;2007年12期

相關(guān)會(huì)議論文 前10條

1 譚騖遠(yuǎn);歸來;牛峰;俞冰;劉劍鋒;;下頜角弧形截骨術(shù)對(duì)咀嚼功能的影響[A];美麗人生 和諧世界——中華醫(yī)學(xué)會(huì)第七次全國(guó)醫(yī)學(xué)美學(xué)與美容學(xué)術(shù)年會(huì)、中華醫(yī)學(xué)會(huì)醫(yī)學(xué)美學(xué)與美容學(xué)分會(huì)20周年慶典暨第三屆兩岸四地美容醫(yī)學(xué)學(xué)術(shù)論壇論文匯編[C];2010年

2 馬夢(mèng)然;王建設(shè);張志誠(chéng);張烈;劉振東;田冠玉;;發(fā)育性髖關(guān)節(jié)脫位髖臼發(fā)育的病理變化與髂骨截骨術(shù)術(shù)后再脫位的關(guān)系[A];2005'中國(guó)修復(fù)重建外科論壇論文匯編[C];2005年

3 金衛(wèi)東;詹學(xué)華;;改良SaIter截骨術(shù)治療發(fā)育性髖關(guān)節(jié)脫位的臨床研究[A];寧夏醫(yī)學(xué)會(huì)骨科分會(huì)第七屆學(xué)術(shù)年會(huì)論文匯編[C];2012年

4 田英俊;;介紹一種矯正肘外翻畸形的截骨術(shù)(英文)[A];第十七屆中國(guó)康協(xié)肢殘康復(fù)學(xué)術(shù)年會(huì)暨第三屆海峽兩岸OS會(huì)議論文匯編[C];2008年

5 陳紅;王忠萍;;LeFortI型截骨術(shù)250例手術(shù)配合[A];全國(guó)手術(shù)室護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2002年

6 解毅;張建中;;改良Ludllof截骨術(shù)后康復(fù)治療[A];中國(guó)康復(fù)醫(yī)學(xué)會(huì)第四屆會(huì)員代表大會(huì)暨第三屆中國(guó)康復(fù)醫(yī)學(xué)學(xué)術(shù)大會(huì)論文匯編[C];2001年

7 蹇洪;譚曉燕;;微創(chuàng)下頜角截骨術(shù)[A];2013年全國(guó)激光醫(yī)學(xué)學(xué)術(shù)聯(lián)合會(huì)議暨2013年浙江省醫(yī)學(xué)會(huì)整形美容學(xué)術(shù)年會(huì)論文匯編[C];2013年

8 文輝才;巫國(guó)輝;柳大烈;;下頜角截骨術(shù)大出血的解剖學(xué)分析及防治策略[A];第七屆中國(guó)醫(yī)師協(xié)會(huì)美容與整形醫(yī)師大會(huì)論文集[C];2010年

9 李浩宇;劉貴麟;許中信;;模擬先天性髖脫位截骨術(shù)的研究[A];第五屆全國(guó)生物醫(yī)學(xué)體視學(xué)學(xué)術(shù)會(huì)議、第八屆全軍軍事病理學(xué)學(xué)術(shù)會(huì)議、第四屆全軍定量病理學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2002年

10 李明;覃佳強(qiáng);張德文;劉傳康;劉星;;三聯(lián)截骨術(shù)治療兒童Perthe's病[A];中國(guó)西南地區(qū)第九屆小兒科學(xué)術(shù)會(huì)議論文匯編[C];2008年

相關(guān)重要報(bào)紙文章 前3條

1 崔猛 朝暉;朝陽縣醫(yī)院成功完成朝陽地區(qū)首例髖臼周圍截骨術(shù)[N];朝陽日?qǐng)?bào);2009年

2 陳祖亮;顱面縱劈截骨術(shù)矯正“凹面人”[N];健康報(bào);2005年

3 陳祖亮;為凹面人“改頭換面”[N];中國(guó)醫(yī)藥報(bào);2006年

相關(guān)博士學(xué)位論文 前1條

1 杜明華;Dega截骨術(shù)治療兒童發(fā)育性髖關(guān)節(jié)發(fā)育不良的臨床初步研究[D];中國(guó)人民解放軍醫(yī)學(xué)院;2016年

相關(guān)碩士學(xué)位論文 前10條

1 羅佼;骨盆三聯(lián)截骨術(shù)治療兒童股骨頭缺血性壞死[D];重慶醫(yī)科大學(xué);2015年

2 趙興賀;Salter截骨術(shù)與Pemberton截骨術(shù)治療學(xué)齡前期發(fā)育性髖關(guān)節(jié)發(fā)育不良臨床Meta分析及臨床觀察[D];蘇州大學(xué);2016年

3 柴家超;Dega vs Steel截骨術(shù)治療大齡兒童發(fā)育性髖關(guān)節(jié)脫位療效分析[D];山東大學(xué);2016年

4 張江南;改良轉(zhuǎn)子間截骨術(shù)聯(lián)合全髖關(guān)節(jié)置換治療重度髖關(guān)節(jié)發(fā)育不良[D];山東大學(xué);2016年

5 于新福;治療發(fā)育性髖關(guān)節(jié)脫位的兩種手術(shù)方式的比較[D];青海大學(xué);2011年

6 梁鷹;髖臼周緣髂骨截骨術(shù)治療先天性髖脫位臨床總結(jié)[D];遼寧中醫(yī)學(xué)院;2003年

7 劉之群;改良伯爾尼髖臼周圍截骨術(shù)治療髖臼發(fā)育不良[D];延邊大學(xué);2010年

8 楊延彬;Salter截骨術(shù)在發(fā)育性髖關(guān)節(jié)脫位手術(shù)治療中的應(yīng)用（附19例報(bào)告）[D];福建醫(yī)科大學(xué);2013年

9 布金鵬;Bernese髖臼周圍截骨術(shù)治療成人髖臼發(fā)育不良的臨床研究[D];山東中醫(yī)藥大學(xué);2004年

10 艾純?nèi)A;改良Salter截骨髖關(guān)節(jié)X線測(cè)量實(shí)驗(yàn)研究[D];延邊大學(xué);2002年

，

本文編號(hào)：1339145