摘要目的:探讨大转子延长截骨（extended trochanteric osteotomy，ETO）与转子下短缩截骨（subtrochanteric shortening osteotomy，SSO）全髋关节置换术治疗CroweⅣ型发育性髋关节发育不良（developmental dysplasia of the hip，DDH）的疗效差异。方法:回顾性收集2012年4月至2020年8月于徐州医科大学附属医院及苏州大学附属第一医院因CroweⅣ型DDH行初次全髋关节置换术的患者40例（51髋）。按术中股骨截骨方式分为：ETO组12例（14髋），男3例、女9例，年龄（49.9±16.7）岁（范围22~75岁），全髋关节置换术中行股骨大转子延长截骨；SSO组28例（37髋），男7例、女21例，年龄（50.3±14.0）岁（范围22~76岁），全髋关节置换术中行股骨转子下短缩截骨。采用Harris髋关节评分（Harris hip score，HHS）、下肢长度差、跛行、Trendelenburg征评价功能效果，随访中摄双髋正位X线片评估截骨处愈合情况、假体周围骨溶解、骨长入及假体松动等，记录并分析并发症情况。结果:40例均顺利完成手术，并获得至少24个月的随访。ETO组、SSO组手术时间分别为（116.8±14.2）、（128.3±19.2）min，总失血量分别为（650.8±191.4）、（808.3±151.3）ml，差异均有统计学意义（ t=2.04， P=0.047； t=3.08， P=0.003）；术后24个月两组HHS分别为（94.8±6.3）、（93.9±4.9）分，下肢长度差为（4.6±2.2）、（5.2±3.0）mm，Trendelenburg征阳性率为7%、16%，跛行发生率为17%、29%，差异均无统计学意义（ P>0.05）；两组股骨短缩长度分别为（30.8±4.1）、（35.3±7.9）mm，差异有统计学意义（ t=2.02， P=0.049）；两组截骨处骨性愈合时间为（5.8±1.5）、（6.0±1.4）个月，术中股骨骨折发生率为36%、65%，差异均无统计学意义（ P>0.05）。所有髋臼和股骨假体均获得骨长入（或骨长上）性固定，无一例发生假体移位，假体周围骨溶解和脱位。 结论:全髋关节置换术治疗CroweⅣ型DDH，术中采用大转子延长截骨或转子下短缩截骨均可获得满意的临床疗效，具有相似的功能恢复和并发症发生率；大转子延长截骨相比转子下短缩截骨缩短手术时间、减少失血量和股骨短缩长度。

abstractsObjective:To investigate the difference in the efficacy of extended trochanteric osteotomy (ETO) and subtrochanteric shortening osteotomy (SSO) in total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH).Methods:Forty patients (51 hips) who underwent primary THA for Crowe type IV DDH from April 2012 to August 2020 at the First Affiliated Hospital of Soochow University and the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The patients were classified into ETO (extended greater trochanteric osteotomy) group and SSO(subtrochanteric shortening osteotomy) group. There were 12 patients (14 hips) in the ETO group, with 3 males and 9 females, aged 49.9±16.7 years old (range, 22-75 years old) and 28 patients (37 hips) in the SSO group, with 7 males and 21 females, aged 50.3±14.0 years (range, 22-76 years). In both groups, Harris hip score (HHS), leg length discrepancy, limp, Trendelenburg sign were used to evaluate the functional results and anteroposterior radiographs of the pelvis were taken at each follow-up to assess bone healing at the osteotomy site, periprosthetic osteolysis, bone ingrowth and periprosthetic loosening. Complications were recorded and analyzed.Results:All 51 hips were followed up for at least 24 months. The operative time and total blood loss was 116.8±14.2 vs. 128.3±19.2 min and 650.8±191.4 vs. 808.3±151.3 ml in the ETO group and the SSO group with significant difference ( t=2.04, P=0.047; t=3.08, P=0.003) respectively. At the follow-up of 24 months the HHS of ETO and SSO groups were 94.8±6.3 vs. 93.9±4.9 points and the leg length discrepancy was 4.6±2.2 vs. 5.2±3.0 mm. The positive rate of Trendelenburg's sign was 7% vs. 16% and the incidence of limp was 17% vs. 29% in the ETO group and the SSO group with no significant difference ( t=0.54, P=0.591; t=0.68, P=0.499; P=0.657; P=0.693). The length of femoral shortening in the ETO group and SSO group was 30.8±4.1 vs 35.3±7.9 mm with significant difference ( t=2.02, P=0.049). Time for bone healing at the osteotomy site was 5.8±1.5 vs. 6.0±1.4 months and the incidence of intraoperative femoral fractures was 36% and vs. 65% with no significant difference ( t=0.45, P=0.657; χ 2=3.52, P=0.061). Bone in-growth (or bone on-growth) fixation was obtained for all acetabular and femoral prostheses, with no hips of prosthesis displacement, periprosthetic osteolysis, or dislocation. Conclusion:Total hip arthroplasty for Crowe type IV DDH can achieve satisfactory clinical efficacy with similar functional recovery and rate of complication in extended trochanteric osteotomy and subtrochanteric shortening osteotomy. However, the extended greater trochanter osteotomy can reduce the operation time, blood loss and length of femoral shortening.