本文選題：髖關(guān)節(jié)發(fā)育不良 + 全髖關(guān)節(jié)置換術(shù)��； 參考：《山東中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：背景：髖關(guān)節(jié)發(fā)育不良(Developmental Dysplasia of the Hip, DDH)是一種臨床常見的成人髖關(guān)節(jié)疾病,臨床現(xiàn)階段大多采用全髖關(guān)節(jié)置換術(shù)(Total Hip Arthroplasty, THA)作為該病的最終手術(shù)治療手段。髖關(guān)節(jié)發(fā)育不良的患者因其患側(cè)髖臼不同程度的骨缺損,往往造成假體臼杯覆蓋率不足。應(yīng)用術(shù)中截下的患者自身股骨頭或自體髂骨作為植骨來源重建缺損髖臼,可獲得滿意的假體覆蓋率及穩(wěn)定性,從而延長(zhǎng)假體壽命,提高患者滿意度。目的：本研究目的在于探究植骨技術(shù)(結(jié)構(gòu)性植骨、顆粒植骨)在髖關(guān)節(jié)發(fā)育不良全髖關(guān)節(jié)置換術(shù)中的應(yīng)用。通過手術(shù)前后影像學(xué)改變及跟蹤觀察、術(shù)前術(shù)后髖關(guān)節(jié)功能評(píng)分等,對(duì)術(shù)后效果進(jìn)行研究與驗(yàn)證,判斷植骨技術(shù)重建髖臼對(duì)行全髖關(guān)節(jié)置換術(shù)的髖關(guān)節(jié)發(fā)育不良病人的手術(shù)短期療效。方法：對(duì)2013年3月至2014年10月山東中醫(yī)藥大學(xué)第一附屬醫(yī)院(山東省中醫(yī)院)關(guān)節(jié)骨科收治的38例髖關(guān)節(jié)發(fā)育不良患者行結(jié)構(gòu)性植骨或顆粒植骨重建髖臼全髖關(guān)節(jié)置換術(shù)。成功隨訪35例40髖,Crowe分型均為Ⅱ、Ⅲ和Ⅳ型；其中Ⅱ型髖21例,Ⅲ型髖13例,Ⅳ型髖6例,平均隨訪時(shí)間為1年。術(shù)前做常規(guī)影像學(xué)檢查,對(duì)髖臼的缺損程度、髖臼附近骨的質(zhì)量及股骨頭情況進(jìn)行術(shù)前評(píng)估。術(shù)中使用小號(hào)髖臼銼對(duì)植骨床骨面進(jìn)行處理,取截下的股骨頭或患者自身髂骨作為植骨來源重建髖臼。隨訪病人術(shù)前做Harris評(píng)分,術(shù)后半年做隨訪評(píng)分,所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)檢驗(yàn),對(duì)手術(shù)效果進(jìn)行綜合判斷。結(jié)果：除1例單髖術(shù)后半年因脫位翻修,2例患者因各種原因未能隨訪成功。成功隨訪35例40髖,均未出現(xiàn)假體松動(dòng)、植骨吸收松動(dòng)。影像學(xué)改變可見植骨與宿主骨融合,接觸面模糊消失,骨小梁重建；未見假體位移及明顯植骨吸收。Harris評(píng)分術(shù)前平均44.99分,術(shù)后半年平均Harris評(píng)分89.53分,明顯高于術(shù)前(PS≤0.01)。以Harris評(píng)分反應(yīng)術(shù)后效果,優(yōu)良率達(dá)100%。結(jié)論：術(shù)后隨訪病人髖關(guān)節(jié)正位X線片可見植骨部分與宿主骨均融合,接觸面隨時(shí)間逐漸模糊甚至消失,且病人術(shù)后Harris評(píng)分相比術(shù)前明顯提高,患者髖關(guān)節(jié)功能顯著改善,提高了患者的生活質(zhì)量。說明人工全髖關(guān)節(jié)置換術(shù)治療髖關(guān)節(jié)發(fā)育不良手術(shù)過程中采用植骨技術(shù)處理髖臼骨缺損對(duì)患者術(shù)后髖關(guān)節(jié)的功能短期內(nèi)具有安全有效的意義。
[Abstract]:Background: developmental dysplasia of the hip (DDH) is a common adult hip disease. Patients with dysplasia of hip joint often have insufficient coverage of acetabular cup because of different degree of bone defect in the affected acetabulum. Using the femoral head or autogenous iliac bone as the source of bone graft to reconstruct the acetabular defect, satisfactory prosthesis coverage and stability can be obtained, thus prolonging the life span of the prosthesis and increasing the patient's satisfaction. Objective: to explore the application of bone grafting (structural bone grafting, granular bone grafting) in total hip replacement with dysplasia of hip. The effect of the operation was studied and verified by imaging changes and follow-up observation before and after operation and the score of hip joint function before and after operation. Objective: to evaluate the short-term effect of acetabular reconstruction with bone grafting in patients with hip dysplasia undergoing total hip replacement. Methods: from March 2013 to October 2014, 38 patients with hip dysplasia were treated in the Department of Joint Orthopedics, the first affiliated Hospital of Shandong University of traditional Chinese Medicine (Shandong traditional Chinese Medicine Hospital). All 35 cases (40 hips) were classified as type 鈪，

本文編號(hào)：2045955