Salter骨盆截骨术治疗髋关节发育不良的中期随访  

Evaluation of mid-term follow-up after Salter innominate osteotomy in developmental dysplasia of the hip

作　　者：刘天婧[1] 石永言[1] 潘诗农[2] 刘振江[1] 赵群[1] 张立军[1] 吉士俊[1] 

机构地区：[1]中国医科大学附属盛京医院小儿骨科,沈阳110004 [2]中国医科大学附属盛京医院放射科,沈阳110004

出　　处：《中华外科杂志》2010年第15期1149-1153,共5页Chinese Journal of Surgery

摘　　要：目的 通过对Salter骨盆截骨术治疗髋关节发育不良术后影像学的测量评估,揭示其术后髋臼形态塑形发育规律,并探讨手术疗效与手术年龄及影像学指标间的关系.方法 回顾性分析1990年1月至2004年12月因髋关节发育不良在我科接受Salter骨盆截骨术治疗的患儿的基本资料.随访时间≥3年且具有完整手术前、后影像学资料的患髋共61髋.选取术前、术后6周取克氏针后、术后1年、术后2～3年及末次随访时的骨盆正位片.测量髋臼指数（AI）、Sharp髋臼角（SAA）和中心边缘角（CEA）,并对末次随访作Severin评级.结果 术后6周时AI平均改善了14°,术后2～3年为髋臼重塑的高峰时期,末次随访SAA平均为41°,基本已达正常水平.术后6周时CEA平均为23°,术后2～3年增加至25°,末次随访为26°.末次随访Severin评级总体优良率（Ⅰ、Ⅱ级）84%,中差（Ⅲ、Ⅳ、Ⅴ、Ⅵ级）16%.年龄越大,优良率越低,但6岁之后仍能获得70%的优良率.术后6周取克氏针时,Severin评级优良患儿和中差患儿改善的AI差异无统计学意义（P＞0.05）;术后2～3年,优良患儿有明显改善,而中差患儿呈恶化趋势,差异有统计学意义（P＜0.05）;至末次随访时,优良患儿与中差患儿Sharp角和中心边缘角差异非常显著（P＜0.05）.结论 Salter骨盆截骨术治疗髋关节发育不良主要改变异常的髋臼开口方向,使股骨头和髋臼同心复位,髋臼获得重塑能力.术后2～3年是髋臼形态重塑最快速的时期,此时各项影像学指标一般逐渐下降至接近正常.若此时各项指标无明显改善或呈变差趋势,中远期疗效不佳.Objectives To evaluate the mid-term outcoming after Salter innominate osteotomy in developmental dysplasia of the hip （DDH） ,and to observe the developmental characteristics of the hip after operation and the relationships between the mid-term outcome and radiographic parameters as well as age at operation. Methods Forty-four patients with 61 treated hips were selected. The patients were treated with Salter innominate osteotomy and followed-up for at least three years with intact serial radiographs. Radiographs taken before operation, 6 weeks, 1 year and 2-3 years after operation and in the latest follow-up were selected. Acetabular index （ AI） , Sharp acetabular angle （SAA） and center-edge angle of Wiberg （CEA） were measured and Severin classification was done according to radiographs taken in the latest follow-up. Results The average correction of AI was 14° postoperatively. The acetabulum remodels best at 2-3 years after operation when the average AI became very close to normal. In the latest follow-up the SAA was 41° which could be regarded as normal. Postoperative CEA was on average 23° which increased to 25° 2-3 years later. In the latest follow-up, the average CEA was 26° . The ratio of excellent and good outcomings （ Severin Ⅰ ,Ⅱ） was 84% , while the ratio of moderate and poor outcomings （ Severin Ⅲ , Ⅳ , Ⅴ , Ⅵ） was 16%. Age at operation had a negative effect on outcomings. Although 70% patients operated after age 6 had satisfactory outcomings. The Severin Ⅰ ,Ⅱ group showed no difference in AI from Ⅲ , Ⅳ, Ⅴ ,Ⅵ group 6 weeks after operation, but the AI of the former obviously improved 2-3 years after operation while that of the latter deteriorated. Significant difference in SAA and the CEA could be observed in the latest follow-up. Conclusions Salter innominate osteotomy focuses on normalizing the abnormal acetabular direction in DDH children as well as stimulating the remodeling of the acetabulum, which provides a satisfactory middle-term outcoming. The

关 键 词：髋脱位 先天性 截骨术 SALTER骨盆截骨术 髋臼指数 中心边缘角 

分 类 号：R726.8[医药卫生—儿科]