| Objective:To discuss adult's developmental dysplasia of the hip(DDH).During the first total hip arthroplasty and subtrochanteric osteotomy,comparing the postoperative clinical effect for different lengths of osteotomy,which provides some relevant reference datum and clinical evidence for preoperative plans and practical lengths of osteotomy.Methods:Review and analyze the documents and the patient who was operated on THA and subtrochanteric osteotomy in Department of Orthopedics,China Japan Union Hospital of Jilin University for the first time from 9th 2014 to 12 th 2016.And choose 22 patients that reach the specifications.All are IV type,a branch type of Crowe.Applying THA and osteotomy and all choosing biological-type prosthesis.Among the patients,4 males and 18 females.Age varies from 35 to 54 and median is 46.6.21 patients are single-side type and 1 is double-side type.Assess the patients' coxa,respectively,before operation,the third month,the sixth month,and the twelfth month after operation.,which includes Harris Marking system of coxa,VAS of coxa's pain,EMG of affected side of coxa,limb vascular ultrasound,X-Ray of coxa,Trendelenburg test,the discrepancy of the limbs length and abnormal gait.Collect the data of osteotomy length before and in operation.Analyze and compare the data.Use SPSS 17.0 to implement related statistical analysis.Define t as continuous variables and P correspondingly.Only when P<0.05,the data is considered meaningful.Results:We got 22 patients in the experiment,among whom 20 didn't appear to suffer Sciatic Nerve Injury and blood vessel injury.2 had the symptoms of nerve stimulation in the region of the sciatic nerve after operation,and got complete relief respectively in the third month and sixth month after operation.17 patients suffered from serious lameness before operation.Another 5 had moderate lameness,and later they experienced system function exercise.Postoperative gait recovery was good.19 restored to normal gait and the other 3 got mild lameness along with positive Trendelenburg.Postoperative markings of coxa(adopting Harris Marking System)was 36~62 average was 38.Postoperative marking reached to 84.5 +/-4.5,among which function marks were 3.0+/-0.8,pain marks were 37.2+/-4.6,cacomelia marks were 3.0+/-0.8,flexibility marks were 3.2+/-0.5.The discrepancies were significative to statistics(t=1.78,P<0.05).VAS of coxa marks recovered from 5.9+/-1.6(before operation)to 1.6+/-1.2(last observation).The aching problem of coxa got solved after the operation.The discrepancies were meaningful to statistics(t=2.19,P<0.05).During the operation,the actual lengths osteotomy were 20mm~65mm,average was 31 mm.Before the operation the scale of affected limbs shrinking were 20~65mm.After the operation,18 patients reached the level of equal lengths;3 shrank 5~10mm on average;one stretched by 8mm.Conclusion:Preoperative rigorous planning and detailed check and intraoperative careful work are key to the success of adult's DDH.The length of subtrochanteric osteotomy doesn't have any sense to practical statistics and under the circumstance when fully loosening the surrounding soft tissue,the lower limbs can be stretched.The author believes that hundred-mark system or other more mathematical unit of individual significance should be adopted to measure the safe range of limb lengthening. |
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