探索启动第二髋关节的手术规律  

Operation Rule for Starting up Second Hip Joint

作　　者：史振满[1] 史疆[1] 王鑫[1] 俞洁[1] 张鹏[1] 郭树章[1] 

机构地区：[1]兰州军区乌鲁木齐总医院全军骨科中心,新疆乌鲁木齐市830000

出　　处：《中国骨与关节损伤杂志》2010年第6期490-492,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探索启动第二髋关节的手术规律。方法观察髋部截骨45例手术前后X线片和CT片的影像学变化。将其分为三组,A组:股骨头坏死行粗隆间外翻截骨30例35髋,测量马蹄角、角赘角和角赘比。B组:髋臼发育不良行髋臼周围旋转截骨15例15髋,其中联合外翻截骨5例5髋,测量手术前后马蹄角,并计算其角度差。C组:取对侧10髋马蹄角做为正常对照。结果髋部截骨术使马蹄角与头赘相关节即启动了第二髋关节。马蹄角均值:A组(19.88±2.27)°;B组术前(30.80±3.93)°,术后(19.27±1.58)°,手术前后角度差(11.53±3.74)°;C组(20.00±1.77)°。A组和B组术后与C组比较,差异无统计学意义。B组术前与B组术后及C组比较,差异有统计学意义。角赘角均值:(30.80±2.09)°。角赘比:1.3∶1。结论第二髋关节的启动规律为:椭圆形股骨头、马蹄角<23°,行粗隆间外翻30°截骨术;圆形股骨头、马蹄角>23°,行髋臼周围前外侧12°旋转截骨术;椭圆形股骨头、马蹄角>23°,行联合截骨术。Objective To explore the operation rule for starting up the second hip joint.Methods The pre-postoperative X-ray and CT image change of the 45 eases of hip osteotomy was observed. They were divided into three groups： group A, 30 cases （35 hips） subjected to femoral head necrosis underwent the inter-trochanter valgus osteotomy, they were measured the horseshoe angle, ang-drop angle and the ang--drop ratio; group B, 15 cases （15 hips） subjected to acetabular dysplasia under went the aeetabulum surrounding rotation osteotomy, they were measured the pre-postoperative horseshoe angle, and calculated the pre-postoperative angle difference; group C, the horseshoe angle of the opposite side 10 hips were the normal comparison.Results The hip osteotomy made the horseshoe angle with the capital drop to construct the second hip joint.The horseshoe angle mean： group A was （19.88±2.27）°; group B the preoperative was （30.80±3.93）°, the postoperative was （19.27±1.58）°, the pre-postoperative angle difference was （11.53±3.74）°; group C was （20.00±1.77）°. Between group A, group C and group B postoperatively, there was no significant difference. Between group A, group C and B group preoperatively, there was significant difference. The angdrop angle mean was （30.80±2.09）°. The Ang-drop ratio was 1.3：1.Conclusion The starting rule if the femoral head is ellipse, and the horseshoe angle is less than 23°, to perform the inter-trochanter osteotomy of valgus 30°; ff the femoral head is spherical, and the horseshoe angle is larger than 23° ,to perform the acetabulum surrounding osteotomy toward ante- lateral rotation 12°; if the femoral head is ellipse, and the horseshoe angle is larger than 23°,to perform the combination osteotomy.

关 键 词：第二髋关节 截骨术 股骨头坏死 髋臼发育不良 

分 类 号：R687.4[医药卫生—骨科学]