| Objective:Retrospective analysis of total hip arthroplasty(THA)performed between September 2015 and May 2020 for the treatment of developmental dysplasia of the Crowe ⅣhipDDH),compared the postoperative efficacy of the two surgical methods of subtrochanteric osteotomy combined with S-ROM prosthesis and non-subtrochanteric osteotomy combined with Wagner Cone prosthesis,and explored the lateral femoral management strategy of Crowe Ⅳ type DDH THA.This can provide reference for the treatment of Crowe Ⅳ DDH in the future.Methods:The clinical data of 55 patients(61 hips)who received THA from September 2015 to May 2020 were retrospectively analyzed,and they were divided into non-subtrochanteric osteotomy combined with Wagner Cone prosthesis(group A)and subtrochanteric osteotomy combined with matched S-ROM prosthesis group(group B)according to the surgical methods.In group A,there were 24 patients(26 hips),including 2 males and 22 females,aged from 24 to 60(3 8.5±10.8)years old,BMI(21.7±1.1)kg/m2,and average dislocation height of(3.7±0.3)cm.In the subtrochanteric osteotomy combined with matched S-ROM prosthesis group(group B),there were 31 patients(35 hips)in group B,including 3 males and 28 females,aged from 23 to 73(41.7±12.5)years old,BMI(21.9±1.2)kg/m2,and average dislocation height(5.8±0.9)cm.The operative time,intraoperative blood loss,postoperative hospital stay and surgical course were recorded in both groups.Harris score,VAS score,patient satisfaction score,SF-36 score and complication rate before and after surgery were recorded in 2 groups to evaluate the surgical efficacy.According to the relevant evaluation indexes,the differences between the two groups of patients with different surgical methods were compared to evaluate the postoperative efficacy.Results:Two groups of patients were statistically compared in terms of gender composition,age and BMI,and the differences were not statistically significant(P>0.05),indicating that the data of the two groups are comparable.The height of femoral head dislocation in group A(3.7±0.3)cm was lower than that in group B(5.8±0.9)cm,and the difference between the two groups was statistically significant(P<0.05).In group A,the operative time was(109.8±12.3)min,the intraoperative blood loss was(413.8±65.5)ml,and the postoperative hospital stay was(8.2±1.3)d.In group B,the operative time was(140.2±13.9)min,the intraoperative blood loss was(490.3±66.3)ml,and the postoperative hospital stay was(11.5±1.7)d.Statistical analysis showed that the operative time,intraoperative blood loss,postoperative drainage volume and length of hospital stay in group A were less than those in group B,and the difference was statistically significant(P<0.05).Patients in both groups were followed up after surgery,group A was followed up from 10 to 66 months,and group B was followed up from 12 to 48 months.In group A,Harris score increased from preoperative(39.5±4.2)to postoperative(87.6±1.8),VAS score improved from preoperative(7.1±0.7)to postoperative(1.8±0.7),SF-36 score increased from preoperative(229.8±12.8)to postoperative(557.1±17.1).The difference was statistically significant(P<0.05).The Harris score of group B was improved from(38.6±3.4)before surgery to(86.9±1.7)after surgery,and the VAS score was improved from(7.2±0.7)before surgery to(1.6±0.7)after surgery.The SF-36 score increased from(226.6.2±12.2)preoperatively to(560.0±16.1)postoperatively,and the difference was statistically significant(P<0.05).At the last follow-up,the satisfaction scores of patients in group A and group B were(3.0±0.6)and(3.1±0.5),respectively,showing no statistically significant difference(P>0.05).Harris score,VAS score,SF-36 score and patient satisfaction score at the last follow-up were not significantly different between the two groups(P>0.05).Conclusion:1.THA is an effective surgical method for the treatment of Crowe Ⅳ DDH,and the use of subtrochanteric osteotomy combined with S-ROM prosthesis or non-femoral subtrochanteric osteotomy combined with Wagner Cone prosthesis during the operation can achieve good clinical effects.2.For patients with femoral head dislocation height less than 4cm,soft tissue contracture around the hip is not serious,and can be reduced by muscle relaxation drugs and soft tissue release,non-femoral subtrochanteric osteotomy combined with Wagner Cone prosthesis is recommended,which can simplify the operation,reduce intraoperative blood loss,and shorten the operation time.For patients with femoral head dislocation height greater than 4cm and still unable to reduce after adequate intraoperative soft tissue release,subtrochanteric osteotomy combined with S-ROM prosthesis is recommended,which can facilitate reduction and reduce the risk of neurovascular injury.3.Crowe type Ⅳ DDH patients have complex anatomical variation,so a comprehensive and detailed preoperative evaluation should be conducted on the patients before surgery,and the surgical method and prosthesis type should be personalized according to the intraoperative conditions. |
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