股骨截骨联合Salter骨盆截骨治疗残余髋臼发育不良的疗效分析  

Efficacy of femoral osteotomy for residual acetabular dysplasia with Salter pelvic osteotomy

作　　者：李大进 张彬 高强 秦海辉 Li Dajin;Zhang Bin;Gao Qiang;Qin Haihui(Department of Orthopedics,Affiliated Xuzhou Children's Hospital,Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属徐州儿童医院骨科,徐州221000

出　　处：《临床小儿外科杂志》2022年第12期1159-1163,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的通过比较Salter骨盆截骨术中是否同时行股骨近端截骨治疗残余髋臼发育不良(residual acetabular dysplasia,RAD)的影像学随访结果,探讨Salter骨盆截骨术治疗RAD时是否有必要常规行股骨近端截骨。方法回顾性分析2018年1月至2018年12月在徐州医科大学附属徐州儿童医院骨科行Salter骨盆截骨治疗的残余髋臼发育不良患儿的临床资料,共28例(32髋)纳入研究。根据是否同时行股骨近端截骨,分为截骨组(A组)与不截骨组(B组)。其中A组14例(15髋),手术时年龄(41.33±2.38)个月,左髋8例,右髋7例(其中双髋1例)。B组14例(17髋),手术时年龄(40.82±2.23)个月,左髋7例,右髋10例(其中双髋3例)。对比两组患儿影像学随访资料,测量指标包括髋臼指数(acetabular index,AI)、c/b比值(股骨近端干骺端最内侧点至中心线的距离/髋臼外缘至中心线的距离)、头部—泪滴距离(股骨近端干骺端内侧角与髂坐骨线之间的水平距离)和头臼覆盖率,中心边缘角(centre-edge angle of Wiberg,CEA)等。结果随访时间:A组为(19.20±8.99)个月,B组为(28.88±7.81)个月,t=3.259,P=0.003;术前与末次随访时AI改善值(ΔAI):A组为(15.77±2.01)°,B组为(15.43±2.99)°,t=-0.372,P=0.712;末次随访时CEA:A组为(33.72±6.53)°,B组为(31.72±8.64)°,t=-0.730,P=0.470;c/b比值:A组为(0.68±0.47),B组为(0.70±0.44),t=1.257,P=0.218;末次随访时头部—泪滴距离:A组为(10.70±1.62)和B组为(11.78±0.87),t=2.380,P=0.024;末次随访时头臼覆盖率:A组为(96.45±4.23)%,B组为(88.93±12.27)%,t=-2.250,P=0.032。随访期间两组均无再脱位发生。按Severin分级,A、B两组优良比例分别为14/15和13/17,χ^(2)=1.719,P=0.190。结论Salter骨盆截骨术治疗小儿残余髋臼发育不良,无需常规同时行股骨近端截骨术。Objective To compare the imaging results of Salter pelvic osteotomy with proximal femur osteotomy or non-osteotomy for residual acetabular dysplasia(RAD)and examine the necessity of proximal femoral osteotomy.Methods From January 2018 to December 2018,clinical data were retrospectively reviewed for 28 RAD children(32 hips)undergoing Salter pelvic osteotomy.They were assigned into two groups of A and B.Group A:proximal femoral osteotomy group(n=14,15 hips),left hip(n=8),right hip(n=7),right hip(n=7),double hip(n=1);group B:femoral non-osteotomy group(n=14,17 hips),left hip(n=7),right hip(n=10),double hip(n=3).The imaging follow-up data of two groups were compared.The relevant measurement parameters included acetabular index(AI),c/b ratio,head-tear drop distance,coverage rate of head&acetabulum and central marginal angle(centre-edge angle of Wiberg,CEA).Results The average follow-up period was(19.20±8.99)months in group A and(28.88±7.81)months in group B(t=3.259,P=0.003).improvement of AI before and at the last follow-up wasΔAI,(15.77±2.01)°in group A and(15.43±2.99)°in group B(t=-0.372,P=0.712);last CEA,(33.72±6.53)°in group A and(31.72±8.64)°in group B(t=-0.730,P=0.47);c/b ratio,(0.68±0.47)in group A and(0.70±0.44)in group B(t=1.257,P=0.218);head-tear drop distance was(10.70±1.62)in group A and(11.78±0.87)in group B(t=2.380,P=0.024);During the last follow-up,head coverage percentage was(96.45±4.23)%and(88.93±12.27)%(t=-2.250,P=0.032);During follow-ups,there was no re-dislocation.According to the Severin classification,the excellent/good rates of two groups were 93.33%(14/15)and 76.47%(13/17)(χ^(2)=1.719,P=0.190).Conclusion During Salter pelvic osteotomy for RAD,simultaneous proximal femoral osteotomy is not required.

关 键 词：发育性髋关节发育不良 残余髋臼发育不良 截骨术 股骨 治疗结果 儿童 

分 类 号：R68[医药卫生—骨科学]