DDHTHAChina先天性髋关节脱位的髋关节置换

DDHTHAChina先天性髋关节脱位的髋关节置换第1页/共44页THAFORDYSPLASIA

ProblemtoOvercomeonAcetabulumProblem:Lateralacetabularbonedeficiencyofvaryingseverity第2页/共44页THAFORDYSPLASIA/LOWDDHACETABULARRECONSTRUCTION第3页/共44页THAFORDYSPLASIA/LOWDDH

AcetabularReconstructionGeneralPrinciples:UncementedsocketOptimizecupstabilityonhostboneDon’tletbonedeficiencydictatecupposition第4页/共44页THAFORDYSPLASIA/LOWDDH

AcetabularReconstructionKeyPoint:UsesupplementalscrewsAvoidpressfitfixationalonewithoutscrewsindeficientacetabulum第5页/共44页THAFORDYSPLASIA/LOWDDH

AcetabularReconstructionTechniqueofarthroplastyisdeterminedbyseverityofantero-lateralacetabularboneloss第6页/共44页THAFORDYSPLASIA/LOWDDH

AcetabularReconstructionMildLateralDeficiency:Routineacetabularreconstruction(uncemented)SlightmedializationofcupifnecessaryAcceptslightlateraluncoverage第7页/共44页第8页/共44页THAFORDYSPLASIA/LOWDDHAcetabularReconstructionModerateLateralDeficiency:MedializehipcentertomedialwallAcceptsomelateraluncoverage(~1.5cm

ofcup)Acceptslightelevationofhipcenter第9页/共44页第10页/共44页第11页/共44页MarkedLateralDeficiency:Options:MedializethroughmedialwallHighhipcenterLateralbulkautogenousfemoralheadgraftTHAFORDYSPLASIA/LOWDDHAcetabularReconstruction第12页/共44页MANAGEMENTOFTHEDYSPLASTICHIP

AcetabularReconstructionMypreference:Medializeto(butnotthrough)medialwallAcceptslightelevationofhipcenterLateralfemheadgraftifneededHighhipcenteronlyinrarecases第13页/共44页第14页/共44页第15页/共44页第16页/共44页10yrs,bonerestoredFEMORALHEADAUTOGRAFTSSlightExtrawork,ExtraRiskTheydobankboneforfuture第17页/共44页THAINDEVELOPMENTALDYSPLASIA

AcetabularReconstructionHighDislocationFalseAcetabulumNotthickorwideenoughforcupfixationTrueAcetabulumThickerbonePosteriorcolumn:bestbone第18页/共44页THAINDEVELOPMENTALDYSPLASIAAcetabulum:ReconstructatanatomiccenterSmallcup,22mheadNograft(usually)Technicaltips:-opensocketwithburr-reaminreverse第19页/共44页第20页/共44页THAFORDYSPLASIA/LOWDDH

ConclusionsAcetabularreconstructioninhipdysplasia:UncementedcupSupplementalscrewsJudiciousmedializationStructuralgraftonlywhennecessary第21页/共44页THAFORDEVELOPMENTALHIPDYSPLASIA:THEFEMORALSIDE

DanielJ.Berry,MDMayoClinic

RochesterMN第22页/共44页THAFORDYSPLASIA

ProblemstoOvercomeonFemoralSideProblemstoovercome:Femoralanatomy:AbnormalneckshaftangleandanteversionLeglength:Variablediscrepancy第23页/共44页THAFORDYSPLASIA

ProblemstoOvercomeFemoralDeformity:Theamountoffemoraldeformitydoesnotalwayscorrelatewithlevelofacetabulardysplasia第24页/共44页THAFORDYSPLASIA

FemoralReconstructionFemoralReconstructionoptions:CementedDDHstemUncementedstem -monoblockproxcoated -monoblockextcoated -modularstem第25页/共44页THAFORDYSPLASIA

FemoralReconstructionCementedFemur:DDHstems,cementhelpmanageabnormalproximalanatomyBut….cementedfixationlessdesirableinmostlyyoungpatients第26页/共44页UncementedPreferredInMostyoungpatientsProxcoatedFullycoatedModular第27页/共44页THAFORDYSPLASIA

FemoralReconstructionMonoblockProximallyCoatedStem:GoodonlyifmilddeformityNotgood(poorfit,anteversionproblems,fracture)ifmoredeformity第28页/共44页THAFORDYSPLASIA

FemoralReconstruction第29页/共44页THAFORDYSPLASIA

FemoralReconstructionFullyCoatedUncementedStems:AllowmoreadjustmentforanteversionSpecialstemsaccommodatevalgusneck?Extensivelycoatedlessdesirableinyoungpatients第30页/共44页THAFORDYSPLASIA

FemoralReconstruction第31页/共44页THAFORDYSPLASIA

FemoralReconstructionModularUncementedStems:ProximallycoatedAllowversionadjustmentRequiresurgeonfamiliarity第32页/共44页THAFORDYSPLASIA

FemoralReconstruction第33页/共44页第34页/共44页第35页/共44页THAFORHIGHDISLOCATIONAcetabularreconstructionatanatomiccenterwithsmallcupNeedtoshortenfemurtoreducehip,minimizesciaticnervestretch第36页/共44页THAFORHIGHDISLOCATION

Traditionalmethod:TrochantericOsteotomy,ProximalShortening,cementedstemDisadvantages:trochanterichealingproblemsproximalfemurbecomes

astraighttube第37页/共44页THAFORDYSPLASIA

HighDislocationNewermethod:SubtrochantericShorteningOsteotomyElegantMaintainsproximal

femoralanatomyAllowsuncementedfemurAvoidstrochantericproblems第38页/共44页THAFORDYSPLASIA

HighDislocationSubtrochshorteningosteotomy:PostapproachOsteotomizefemur,translateanteriorlyPlacecupShortenfemurPlaceuncementedstemStemwithbeadsorflutes:fixesosteotomy第39页/共44页第40页/共44页第41页/共44页THAFORHIPDYSPLASIA

SciaticNerveLengthening:howmuchissafe?Nodefiniteguidelinesbutbewarewhen

over2cm