1陈继营-tha股骨重建.docx

DDH股骨侧重建 解放军总医院骨科 陈继营王岩周勇刚董纪元郝立波张国强柴伟 DDH患者 ?我国先競儿童诊疗滞后 ?许多患者成年后需要外科治疗 ? DDH及幼年髓关节疾病后遗症（占 競关节置换患者的16.8% ） 术前明显外翻，轻度关节炎内翻截骨 术前明显外翻，轻度关节炎 内翻截骨 截骨重建 Table 2 Results of the Bernese Peri acetabu I ar Osteotomy in Dysplastic Hips Study No. of Osteotomies (Patients) Mean Age (Range) Mean FolkW" up (Range) (yO No. (%) of Patients With Tonriis Grade 3 Preoperative OA Siebenrock st al10 71 (60) 29 3 (1J-56) 11 3 (10.0- 13.8) 2(4) Trousdale etal11 42 (42) 37(41- 56) 4(2-8) 9(21) Crockarell etal3 21 (19) 21⑴一 43) 3 2 (2 0- 4.3) 0 Malta et 別2 66 (58) 33.6 (19-51) 4(2-10) 12(18) Trumble et al13 123(115) 32.9 (14-54) 43 (2- 10) 18(15) No. (%) Of Combi ned/Subse querit Femoral Osteotomies No. (%) ofConversionsto TUR ClinicalResults*(Patients) Major Complications1 13 3 g 16 3 Percentage of good or excellent (GJE) results or improvement in average Harris hip score Major complicanons include neurovascular injury, iritra-articular osteotomies, loss of correction, resubluxation, nonunion, infection, or symptomatic heterotopic ossification. ：Second oswotonnies in six parients and fusionin one patierit. 'Three more patients aveii hip reconstnjdion. Femoral osteotoni^ or trochanteric advancement. OA = osteoarthritis; THR = roral hip replacement 骨盆韻臼同时截骨 全韻关节置换  骯关节发育不良者股骨侧解剖畸形 颈讎 前倾角 -辱鶴高颈干角越小(Flecher) 3353? 當豐 (IV型 124.20 ±3.87) 38.53 ± 2.30 (曹力等) I-III 型 DDH 术前模板测量，术中调整前倾角，备S?rom ?安全的初始稳定?能复位至真臼前倾 ?安全的初始稳定 ?能复位至真臼 前倾 IV型DDH股骨假体置换 ?适应股骨的特殊解 剖一一远近端细* 直 粗隆部截骨 (Dunn HK, Hess WE: Total hip reconstructio n in chronically dislocated hips, J Bone Joint Surg 58A:838, 1976.) 粗隆下截骨g 截骨部位 ?恢复股骨近端解剖 ?可以采用非水泥固定 ?避免了粗隆截骨并发症 ?调整前倾角 粗隆下截骨 粗隆下截骨 不稳定 一?'、 L 一?' 、 L 1 ?骨板固定 ?钢板固定 Li XG, Pan WM ?截骨端形状 —横形 -斜形 -台阶状截骨 -V形截骨 -W形截骨 Double Chevron Subtrochanteric Shortening Derotational Osteotomy in Cementless Total Hip Arthroplasty for Crowe Type IV Congenital Dislocation of the Hip. JOA 组合式假体S?ROM假体 早期担心截骨端稳定性  适用于各种情况 我科最近3年来 ?共235例高脱位DDH ?绝大多数获得良好疗效 ?并发症 - 2例脱位 -15例劈裂骨折 -2例坐骨神经轻微损伤 -1例无菌松动 并发症 ?先