Dysplasia mmepe nke hip (DDH) bụ nsogbu mmepe siri ike nke na-eme ka ọ ghara ịrụ ọrụ hip n'ihi ọrịa dysplasia nke acetabulum, nrụrụ femoral proximal, nkwekọrịta anụ ahụ dị nro na-agbanwe agbanwe, na mgbanwe biomechanical. Mkpokọta arthroplasty hip (THA) bụ otu n'ime ụzọ ndị bụ isi maka ọgwụgwọ DDH, nke nwere ike ịkwụsị esemokwu nke anụ ahụ dị nro, weghachite ebe ntụgharị na nkwụsi ike nke nkwonkwo hip, ma melite nrụrụ nke akụkụ ụkwụ dị ala. E jiri ya tụnyere ụdị Crowe Ⅰ ~ Ⅲ ndị ọrịa DDH, dayameta anteroposterior nke acetabulum dị ntakịrị na nke na-emighị emi, na mgbanwe dị iche iche nke ihu ihu dị ukwuu; dysplasia isi femoral ọbụna na-apụ n'anya, akụkụ ihu femoral nke femoral ka ukwuu, nnukwu trochanter dị n'azụ, na dayameta anteroposterior nke femur karịrị aka ekpe na dayameta aka nri [1-2]; E jiri ya tụnyere femur nkịtị, paramedullary intramedullary gbanwere nke ukwuu, karịsịa oghere medullary dị obere ka ọ dị ntakịrị. Mgbapụ hip na-adịte aka butere nkwekọrịta anụ ahụ dị nro dị njọ karịa mpaghara, na-ebute ihe isi ike na mbelata hip [4]. Ya mere, nguzobe nke nkwonkwo hip kwụsiri ike na mgbake nke ọkpụkpụ ọkpụkpụ aghọwo otu n'ime ihe isi ike na ịwa ahụ.
1. Kedu ihe kpatara ịchọrọ ịwa ahụ ngbanwe?
Isi ihe kpatara ntụgharị mgbe mmalite THA dị na ụdị Crowe Ⅳ DDH bụ aseptic ịtọpụ prosthesis. Tụkwasị na nke ahụ, ọrịa periprosthetic, ọkpụkpụ periprosthetic, osteolysis, ọkpụkpụ ọkpụkpụ na ọkpụkpụ prosthesis na enweghị ike bụkwa ihe na-akpata ntụgharị..
2Nhazi ntụpọ ọkpụkpụ
Akụkụ acetabular na femoral nke ụdị Crowe Ⅳ DDH ndị ọrịa na-esonyere ya na ụfọdụ nrụrụ ọkpụkpụ n'oge ntugharị, na ọkpụkpụ fọdụrụnụ na ntụpọ nke acetabular na proximal femur nwere ike tụọ X-ray na CT tupu ntughari. N'oge ugbu a, nke a na-ejikarị eme ihe n'ịgwọ ọrịa ọkpụkpụ na-adịghị mma bụ ọkọlọtọ Paprosky classification classification, na ọkwa nke femur nke femur na femur nke femur. chịkọtara.
2.1Paprosky's acetabular nhazi ọkwa
Ọkpụkpụ ntụpọ ọkpụkpụ nwere ike ọ bụghị nanị na-egosi ogo nke ọkpụkpụ ọkpụkpụ, ma na-egosipụtakwa nkwụsi ike nke prosthesis acetabular a kụnyere [5-6], ka ịhọrọ prosthesis akụkụ nke acetabular kwesịrị ekwesị na components.Paprosky nhazi ọkwa dabere na nchọpụta imaging iji nyochaa ntụziaka na ogo nke acetabular cup displacement, iji kpee ikpe ogo nke acetabular nke ọkpụkpụ, na njedebe nke ọkpụkpụ ọkpụkpụ, na-ekpebi njedebe nke acetabular nke ọkpụkpụ, na njedebe nke ọkpụkpụ ọkpụkpụ. A ga-ekewa n'ime ụdị atọ. Ụdị ⅰ: obere ego na ọkpụkpụ ọkpụkpụ dị oke gburugburu acetabulum, nke ka nwere ike ịnọgide na-enwe ọdịdị mbụ na nhazi nke acetabulum.Type Ⅱ: ntakịrị ntugharị nke elu medial, elu mpụta na medial acetabulum, ma ihu na azụ na ogidi nke acetabulum ka dị mkpa nke ọma ma ọ bụrụ na ọkpụkpụ ahụ ka na-edozi nke ọma, ma nwee ntụpọ pụrụ iche. Cage iji rụkwaa na reconstruct.Type III: The acetabulum nwere ọnụ ọgụgụ dị ukwuu nke ọkpụkpụ ọkpụkpụ annular, etiti etiti nkwonkwo ụkwụ na-agbago elu (> 3 cm) [7-8], na ọbụna nkwụsị ọkpụkpụ ma ọ bụ nkwụsị nke pelvic, nke bụ ụdị nkwarụ ọkpụkpụ kachasị njọ na akụkụ acetabular. Nrụgharị Acetabular na mweghachi nke etiti ntụgharị na-emetụta ihe ịga nke ọma ma ọ bụ ọdịda nke ịwa ahụ ngbanwe. Lee eserese 1.
2.2Nhazi nke Paprosky nke akụkụ femoral
Nhazi nke Paprosky nke akụkụ femoral na-adabere n'ókè nke ọkpụkpụ ọkpụkpụ na nso nso na distal isthmus nke femur, gụnyere ọnọdụ nke ọkpụkpụ ọkpụkpụ, ogo nke ọkpụkpụ fọdụrụnụ nke dị nso, ogologo nke isthmus na ọkpụkpụ ya na-akwado ọkpụkpụ, a na-ekewa ya n'ime ụdị atọ. Ụdị Ⅰ na Ⅱ: dị mfe iji mebie ọkpụkpụ na-adịghị mma n'oge metaximal. Ntughari.Type III: nrụrụ dị nso nso, mana ọkpụkpụ femoral ka na-adịgide adịgide, dabere ma ogologo ọkpụkpụ fọdụrụnụ na isthmus nke femur ruru 4 cm [9].
3Nrụgharị nke acetabulum
N'ihi nrụrụ nhazi nke ụdị Crowe Ⅳ Ndị ọrịa DDH na usoro mgbagwoju anya mgbe mgbanwe nke mbụ gasịrị, ọtụtụ n'ime prostheses ntụgharị enweghị ike nweta nkwụsi ike nke mbụ nke nkwonkwo, mkpuchi ọkpụkpụ zuru oke ma ọ bụ melite nrụrụ morphological.
3.1Ngwa nke iko edoziri ndu
Mgbe enwere ụdị Paprosky II ma ọ bụ n'elu ọkpụkpụ ọkpụkpụ dị na acetabulum na iko ọkọlọtọ nkịtị nke hemispherical hemispherical acetabular cup enweghị ike inye nkwụsị siri ike, a pụrụ iji nnukwu prosthesis acetabular cup (Jumbo cup) mee ka ebe kọntaktị na ọkpụkpụ dị n'akụkụ acetabulum dịkwuo elu ma mee ka ihe mgbakwunye ahụ dịkwuo elu, iji nweta nkwụsi ike ogologo oge.
3.2Ọkpụkpụ grafting
Akaaka ọkpụkpụ na-emetụta bụ usoro mmezi ntụpọ ọkpụkpụ a na-ejikarị eme ihe na ụlọ ọgwụ. Maka ndị ọrịa nwere obere nkwarụ ọkpụkpụ acetabular, ọkpụkpụ aka ma ọ bụ prosthesis dị ka mgbanaka na-agba ume, ngọngọ ígwè na Cage nwere ike iji weghachite ọkpụkpụ ọkpụkpụ, arịa ọbara na-emepụta, ọkpụkpụ ọkpụkpụ ma melite ọkpụkpụ ọkpụkpụ na nkwarụ ọkpụkpụ acetabular, iji nweta nzube nke nkwụsi ike ogologo oge nke prosthesis [10].
3.3Ngwa nke metal augments
N'otu oge ahụ, kọntaktị ebe n'etiti ọkpụkpụ anụ ahụ na ntụpọ saịtị na metal ngọngọ na-abawanye, nke nwere ike na-akwalite ọkpụkpụ ingrowth.The metal blocks nwere dị iche iche shapes na nha, na ike inosculated na ọkpụkpụ ntụpọ akụkụ nke kasị ukwuu n'ókè site na-ahọpụta a kwesịrị ekwesị metal block.Tantalum ngọngọ na ọkpụkpụ trabecular metal prosthesis nwere ezi ndu e ji mara na esemokwu ọnụ ala, na-amụba na ojiji nke metal ntụpọ nwere ike imezi ihe na-eme ka ọkpụkpụ acetament na-emeziwanye ihe na-eme ka ọkpụkpụ na-eme ka ọ dịkwuo mma. nkwụsi ike.
3.4Ngwa nke onu & iko nku atọ
Enwere obere ọkpụkpụ na mgbidi medial na kọlụm dị n'ihu nke ụdị Crowe Ⅳ DDH ndị ọrịa, na ụfọdụ ndị ọrịa nwere nnukwu ọkpụkpụ ọkpụkpụ n'oge ịwa ahụ na-emegharị, na-eme ka nkwụsị acetabular kwụsị, na iko acetabular enweghị ike idozi nke ọma n'oge ntụgharị, ya mere enwere ike iji Cage ma ọ bụ iko acetabular nwere nku atọ maka nwughari acetabulum n'oge a.
3.5Nkà na ụzụ obibi akwụkwọ 3D
N'ime ndị ọrịa nwere ụdị Paprosky ụdị Ⅲ ọkpụkpụ ọkpụkpụ, acetabulum adịghị aga n'ihu n'ihi nnukwu ọkpụkpụ ọkpụkpụ, nke na-eduga n'ịkwụsị pelvic na ihe isi ike na ntinye nke prosthesis acetabular. Enwere ike iji teknụzụ obibi obibi 3D mee ụdị akụkụ atọ nke pelvis nke onye ọrịa, nke onye ọrụ nwere ike ịghọta n'ụzọ doro anya ntụpọ anatomical nke acetabulum, ghọta usoro anatomical mpaghara na oke ntụpọ ahụ, atụmatụ dị mma tupu arụ ọrụ, họrọ ihe kwesịrị ekwesị iji rụkwaa ntụpọ ahụ, ma ọ bụ jiri teknụzụ obibi 3D iji kwadebe ihe nkwado pụrụ iche nke prosthetic, mgbake na mgbake nke hip.
4Nrụgharị nke akụkụ femoral
4.1Ihe isi ike ịwa ahụ
.Nrụrụ femoral na ndị ọrịa DDH gbanwere na ogo nke nkwụsị hip. N'ime ha, ụdị Crowe IV na-egosipụta site na nkwụsị elu nke nkwonkwo hip, mgbanwe kachasị njọ na morphology na ọrụ nke femur proximal, na nnukwu ọnọdụ nke coxa vara na valgus [11-12]. Mgbe akụkụ femoral nke ndị ọrịa DDH na-atọ ụtọ ma na-esonyere ya na oghere na ọkpụkpụ ọkpụkpụ nke akụkụ, ngbanwe nke akụkụ femoral bụ ihe ịma aka. Dị ka mwepụ nke ntinye, ichekwa ọkpụkpụ ọkpụkpụ, nwughari nke femur dị nso, nhọrọ nke ntinye prosthesis kwesịrị ekwesị na nkwụsi ike aghọwo ihe isi ike nke ịwa ahụ femoral revision [13].
4.2Akpachara anya maka ịrụ ọrụ
Enwere ike ịnwe osteosclerosis na femur dị nso na oghere medullary dị warara nke ụdị Crowe Ⅳ DDH ndị ọrịa n'oge ịwa ahụ ngbanwe. Mgbe ị na-ewepụ prosthesis femoral femoral biological, anụ ahụ ọkpụkpụ sclerotic na anụ ahụ fibrous nke a na-etinye na femur dị nso kwesịrị iwepụ ya dị ka o kwere mee, a ga-ewepụkwa prosthesis ahụ n'ụzọ zuru ezu na ọkpụkpụ-prosthesis interface kwesịrị ịkewapụ iji belata ọkpụkpụ ọkpụkpụ iatrogenic. Iji gbochie ihe omume nke cortical perforation na mgbaji kpuo ìsì 5. ihe ịga nke ọma ma ọ bụ ọdịda nke ịwa ahụ ntugharị na-adabere na nyocha tupu ịwa ahụ na intraoperative nke ogo nke ọkpụkpụ femoral dị nso, nhazi, nhọrọ na nhazi nke prosthesis etinyere, na ikpe nke ịdị mma nke ọkpụkpụ fọdụrụnụ.
4.3Kedu ka esi ahọrọ azuokokoosisi ziri ezi?
A na-ejikarị prosthesis modular modular eme ihe n'ịwa ahụ nke Crowe Ⅳ DDH ndị ọrịa. The segmental modular prosthesis nwere ike ka mma izute n'ezie mkpa nke femur nke onye ọrịa, na distal femoral azuokokoosisi nwere ike nweta adaptive nkwụsi ike, na proximal cuff nwere ike n'ụzọ dị irè gbochie postoperative osteolysis na fixation loosening.N'ihi na Crowe revision kwesịrị ka a họrọ femur femur nke DH. nkwarụ femoral nke onye ọrịa, ka o wee nweta nwughari femoral ma nọgide na-enwe nkwụsi ike nke prosthesis dị ka nzube mbụ.
5Kedu ka esi ahọrọ liner?
Ka ọ dị ugbu a, mkpuchi prosthesis nke a na-ejikarị na ịwa ahụ gụnyere metal-metal interface, metal-polyethylene interface, ceramic-polyethylene interface na ceramic-ceramic interface [7,11].Polyethylene ihe bụ isi ụdị nhọrọ ugbu a. Ka ọ dị ugbu a, mkpuchi polyethylene jikọtara nke ukwuu ejirila nwayọọ nwayọọ dochie mkpuchi polyethylene ọdịnala, nke nwere oke mgbochi na-eyi, na-ebelata osteolysis na eyi n'etiti prostheses mgbe arụchara ọrụ, ma na-enyere aka ịnọgide na-enwe ogologo oge prognosis [16] . Ọtụtụ ndị ọrịa nwere ụdị Crowe Ⅳ DDH bụ nwata mgbe ha nwetara isi THA, na ha nwere nnukwu ọrụ kwa ụbọchị. N'ịtụle nrụrụ ọkpụkpụ nke ihe na-eyi ihe na-eme n'oge ntughari na ihe isi ike nke ntughari, a ga-ahọrọ akwa seramiiki dị ka o kwere mee n'oge isi THA ma ọ bụ ntụgharị. Ọ bụrụ na ọ gaghị ekwe omume ịhọrọ n'ihi oke oke, enwere ike ịhọrọ polyethylene lining nke nwere njikọ chiri anya [17].Ka ọ dị ogologo ndụ ọrụ prosthesis ma belata ọnụ ọgụgụ nke ọrụ nyocha.
6Mmechi
.Aseptic ịtọpụ prosthesis bụ ihe kachasị akpata ntugharị mgbe mmalite THA maka ụdị Crowe Ⅳ DDH. Ntugharị ugboro ugboro nke nkwonkwo, nkwarụ ọkpụkpụ, ọrịa, enweghị njikọ na saịtị osteotomy, na ọkpụkpụ prosthesis nwekwara ike ime ka ịwa ahụ gbanwee. Nrụgharị nkwonkwo hip na ntinye prosthesis femoral bụ isi ihe isi ike na ịwa ahụ maka ndị ọrịa dị otú ahụ, nke chọrọ nyocha zuru oke na nke ziri ezi na nyocha tupu ịwa ahụ, na-ewere nkọwa zuru ezu nke ogo onye ọrịa na ọnọdụ ọkpụkpụ na-adịghị mma. Nrụrụ ọkpụkpụ ka bụ nsogbu kachasị mkpa na ịwa ahụ ngbanwe maka ndị ọrịa Crowe IV DDH. Ọ bụ ezie na nkà na ụzụ Cage, modular components na prosthesis ahaziri egosiwo na ọ ga-arụ ọrụ nke ọma n'oge mbụ na nke etiti oge a, ọnụ ọgụgụ nlanarị ogologo oge ka kwesịrị ka a dokwuo anya. Site na mmepe na-aga n'ihu nke nkà na ụzụ ọgụgụ isi nke nkà na ụzụ na-ahụ maka ahụike, ihe ndị na-emepụta prosthesis ahaziri onwe ga-enyekwa nhọrọ ndị ọzọ maka nyocha nke ndị ọrịa dị otú ahụ.
Ntụaka
[1] Bilgen ÖF, Salar N, Bilgen MS, et al. Mmetụta nke ụdị dislocation (ụdị Crowe Ⅰ-Ⅳ) na mmepe pelvic na mmepe dysplasia nke hip: ihe ọmụmụ rediologic nke anatomy. J Arthroplasty,2015, 30 (5): 875-878.
[2] Yang Y, Liao W, Yi W, et al. Ọmụmụ morphological akụkụ atọ nke femur proximal na ụdị Crowe Ⅳ mmepe dysplasia nke hip. J Orthop Surg Res, 2021, 16 (1): 621. doi: 10.1186/s13018-021-02789-5.
[3] Liu S, Zuo J, Li Z, et al. Ọmụmụ ihe ọmụmụ nke akụkụ atọ nke femur proximal na mmepe dysplasia nke hip na-egosi na prosthesis modular na shelf nwere ike ọ gaghị abụ ezigbo nhọrọ maka ndị ọrịa nwere ụdị Crowe Ⅳ hips. Int Orthop, 2017,41 (4): 707-713.
[4] Kilicarslan K, Yalcin N, Cicek H, et al. Kedu ihe na-eme na nkwonkwo ikpere dị n'akụkụ mgbe ngụkọta ọkpụkpụ arthroplasty nke ụdị Crowe Ⅲ na Ⅳ dysplastic hips? J Arthroplasty, 2012, 27 (2): 266-270.
[5] Gallo J, Goodman SB, Konttinen YT, et al. Ọrịa urughuru: usoro ndu nke osteolysis periprosthetic na mkpokọta arthroplasty hip. Mmụba Immun, 2013, 19 (2): 213-224.
[6] Brown JM, Mistry JB, Cherian JJ, et al. Ntụgharị akụkụ femoral nke mkpokọta arthroplasty hip. Ọkpụkpụ, 2016, 39 (6): e1129-e1139.
[7] Telleria JJ, Gee AO. Nhazi na nkenke: Nhazi nke paprosky nke ọkpụkpụ acetabular. Clin Orthop Relat Res, 2013, 471(11):3725-3730.
[8] van der Donk S, Buma P, Slooff TJ, et al. Ntinye aka nke ọkpụkpụ chara acha: nyocha nke ụdị 24 acetabular biopsy. Clin Orthop Relat Res, 2002(396): 131-141.
[9] Sugano N, Noble PC, Kamaric E, et al. Ọdịdị nke thefemur na mmepe dysplasia nke hip. J ọkpụkpụ nkwonkwo Surg (Br), 1998, 80 (4): 711-719.
[10] Du Y, Li T, Sun J, et al. Mmetụta nke acetabulum ụgha na ọwa mmiri femoral proximal medullary dị n'ụdị Crowe dị n'otu akụkụ Ⅳ mmepe mmepe nke hip. The Clin Risk Manag, 2020,16: 631-637.
[11] McCarthy JC, Lee JA. Mgbagwoju anya nlegharị anya mkpokọta hip arthroplasty nwere mkpịsị modular n'ihe dị ka afọ 14. Clin Orthop Relat Res, 2007, 465: 166-169.
[12] Sheth NP, Melnic CM, Rozell JC, et al. Nlekọta nke ọkpụkpụ femoral siri ike na nhazigharị mkpokọta arthroplasty hip. Orthop Clin North (Am), 2015, 46 (3): 329-342.
[13] Burstein G, Yoon P, Saleh KJ. Mwepụ akụkụ na ntughari mkpokọta ogbunigwe hip. Clin Orthop Relat Res, 2004(420): 48-54.
[14] Wang S, Zhou Y, Ma H, et al. Nsonaazụ etiti oge nke ngụkọta ngbanwe hip nwere osteotomy subtrochanteric, stem modular, na ceramic surface na Crowe Ⅳ dysplasia hip. Arthroplast
Taa, 2017, 4 (3): 363-369.
[15]Bryan AJ, Calkins TE, Karas V, et al. Ngụkọta nkwonkwo hip primary na ndị ọrịa na-erubeghị afọ 50 n'ihe dị ka afọ 16: polyethylene nwere njikọ chiri anya nke ukwuu na-ebelata ohere nke nyochagharị. J Arthroplasty, 2019, 34(7S): S238-S241.
[16]Amanatullah DF, Howard JL, Siman H, et al. Ndozigharị mkpokọta ogbu na nkwonkwo hip n'ime ndị ọrịa nwere nnukwu ọkpụkpụ femoral dị nso site na iji akụrụngwa femoral modular gbatịrị amịkpọ. Njikọ ọkpụkpụ
J, 2015, 97-B(3): 312-317 .
[17]Smith AJ, Dieppe P, Vernon K, et al. Ọnụego ọdịda nke ihe nnọchi hip-metal-on-metal butere: nyocha nke data sitere na Ndekọ Njikọ Mba nke England na Wales. Lancet, 2012, 379 (9822): 1199-1204.
Oge nzipu: Eprel 16-2024