| Background: Developmental dysplasia of the hip(DDH)is a common orthopedic disease in clinic.In the treatment of DDH,the most widely used method is total hip arthroplasty(THA).Because most patients with severe DDH have different degrees of bone defects in the acetabulum,how to reconstruct the acetabulum is a big problem in tha.Autologous structural bone graft is widely used in the field of bone and joint because it can fully fill the bone defect,make the acetabulum in situ reconstruction,easy to obtain materials and low cost.Studies have shown that patients with acetabular reconstruction using autologous structural bone graft have achieved good short-term results,but there are also reports of a large number of bone resorption in the bone graft area after longterm follow-up,and there is still no consensus on the medium and long-term results.Objective: To evaluate the mid-term effect of acetabular reconstruction with autologous structural bone graft in the treatment of adult hip dysplasia.Methods:From January 2010 to January 2016,30 hips with DDH treated by THA with autologous bone graft in the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed.There were 17 females(20 hips),10 males(10 hips),and 30 hips were treated with autologous structural bone graft to improve acetabular bone defect.The average follow-up time was(6.06±0.78)years.According to Crowe’s classification of hip dysplasia,30 cases of hip dysplasia were divided into 16 cases of Crowe Ⅱ,8 cases of Crowe Ⅲ and 6 cases of Crowe Ⅳ.The stability of acetabular cup and the survival rate of bone graft were further discussed.Results: All the 27 patients had osseointegration between the grafted bone and the host bone.The acetabular prosthesis was stable,and there was no obvious radiolucent shadow around.However,2 patients had mild osteolysis of the grafted bone,and 1 patient had revision due to loosening of the prosthesis.Harris score increased from(45.33 ± 8.10)preoperatively to(80.03 ± 5.15)at the last follow-up.The length difference of lower limbs decreased from(3.54 ± 0.83)cm preoperatively to(0.65 ± 0.36)cm at the last follow-up.The results were statistically significant compared with those before operation.The postoperative hip pain symptoms were significantly alleviated and the function was significantly improved.The acetabular coverage decreased from(119.83 ± 7.39)% to(111.50 ± 6.57)% at the last follow-up,but it was higher than(60.60 ± 5.12)%.CE angle increased from(15.97 ± 2.25)° preoperatively to(46.96 ± 1.43)° postoperatively,but decreased to(46.51 ± 1.52)° at the last followup,sharp angle decreased from(46.03 ± 2.72)° preoperatively to(36.53 ± 1.59)° postoperatively,and the difference was statistically significant(36.74 ± 1.74)at the last follow-up.Conclusion: In patients with developmental dysplasia of the hip undergoing total hip arthroplasty,structural bone autograft is used to reconstruct the acetabulum,only a few grafts will have a certain degree of osteolysis,but can still obtain effective bone integration;structural bone autograft can effectively improve the acetabular bone defect,increase bone reserve,and is conducive to the recovery of hip joint rotation center andrecovery The length of lower limb and mid-term follow-up confirmed that it is reliable to improve acetabular bone defect by autologous structural bone graft. |
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