تبديل الورك الكامل عند مرضى عسر تصنع الجوف الحقي باستخدام حلقة الدعم

الملخص EN

Background: coxathrosis secondary to the untreated developmental dysplasia of the hip is still encountered against all the screening and early treatment methods.T.H.A in DDH presents challenging surgical problems to the orthopedic surgeons due to the associated anatomical changes and the technical difficulties related to the bone deficiency in the acetabulum.

The purpose of the study is to examine the clinical and technical problems associated with reconstruction of the hip in patients with congenital dysplasia and to offer recommendations for their Solutions.

Material and methods: we performed T.H.R on 44 hips congenitally dislocated for the treatment of the secondary osteoarthritis in AL-ASSAD Hospital in Damascus between 1999-2006.

The study consisted of 36 patients who had had a total of 44 reconstructions of acetabulum.A minimum of 5 years of follow-up was required for inclusion in the study with mean follow up of 6,3 years.The study was prespective.

According to the classification of Crow et al,four hips had type-4 acetabular dysplasia,thirty five hips had type-3,and five hips had type-2.

In our study we followed the principle of restoration of hip centre and Acetabular reconstruction was performed with use of the Muller acetabular roof reinforcement ring and polyethylene cup,which was inserted with cement.Auto graft from the femoral head was used as bulk structural graft or morsellised bone graft.

The results was described as excellent for 29 hips(65,9%),as good for 9 hips (20,4%),as fair for 3 hips (6,8%),and as poor for 3 hips (6,8%).

Three of the hips had been revised (6,8%) because of aseptic loosening of acetabular component.

Intraoperative complication included one fracture of the femoral sheft (2,27%),A sciatic neurppraxia developed postoperatively in three patients who had a high dislocation (6,8%),two patients had postoperative dislocation (4,54%),but neither needed revision,Two patients had superfacial infection (4,54%),three patients had D.V.t(6,8%) and treated by low molecular heparin.

The conclusion:Our study showed that restoration of the anatomical hip centre and use of reinforcement ring with autogenous bone grafting in T.H.A of congenitally dislocated hips yielded favorable results during a mean follow up of 6,3 years