髋臼周围旋转截骨术联合髋关节镜治疗中青年髋臼发育不良  

TREATMENT OF ADULT DEVELOPMENTAL DYSPLASIA OF THE HIP BY ROTATIONAL ACETABULAR OSTEOTOMY COMBINED WITH DEBRIDEMENT UNDER ARTHROSCOPE

作　　者：廉永云[1] 刘雪峰[1] 逯代锋[1] 周勇[1] 王鲲鹏[1] 刘全[1] 周振熙 

机构地区：[1]哈尔滨医科大学附属第四医院骨科,哈尔滨150001 [2]黑龙江省民政慈善医院康复科

出　　处：《中国修复重建外科杂志》2011年第7期821-825,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价髋臼周围旋转截骨术(rotational acetabular osteotomy,RAO)联合髋关节镜下关节清理治疗中青年髋臼发育不良(developmental dysplasia of the hip,DDH)的有效性。方法回顾分析2002年4月-2007年8月采用改良RAO联合髋关节镜下关节清理术治疗的24例29髋中青年DDH患者临床资料。男2例2髋,女22例27髋;年龄21～50岁,平均37.7岁。左髋7例,右髋12例,双髋5例。髋部疼痛时间8～216个月,中位时间30.5个月。DDH根据Crowe分型标准:Ⅰ型24髋,Ⅱ型5髋。根据T?nnis髋关节骨关节炎分级系统评定:Ⅰ期20髋,Ⅱ期9髋。结果手术时间为120～180 min,平均150 min;术中出血量为500～700 mL,平均600 mL;术后引流量为50～400 mL,平均200 mL。术后患者切口均Ⅰ期愈合。24例均获随访,随访时间3～8年,平均4.5年。末次随访时,16例跛行症状消失,8例步态改善;髋关节Harris评分由术前的(79.4±9.8)分提高至(95.1±8.6)分(t=2.467,P=0.010),疼痛视觉模拟评分(VAS)由术前的(5.1±0.8)分改善至(1.1±0.6)分(t=2.118,P=0.011)。X线片检查示截骨部位于12～16周达骨性愈合,平均13.5周;末次随访时髋臼中心边缘角、Sharp角、髋臼覆盖率及头臼指数与术前比较,差异均有统计学意义(P<0.05)。末次随访时,20髋术前T?nnisⅠ期骨关节炎患者,均维持Ⅰ期;9髋Ⅱ期患者中,5髋改善为Ⅰ期,4例维持Ⅱ期。结论对有髋部疼痛症状的中青年DDH患者,早期通过RAO改善髋臼对股骨头的包容、匹配程度,并联合髋关节镜下关节清理术改善髋关节腔内环境,可以改善DDH临床症状和髋关节功能,延缓或阻止骨关节炎的进展。Objective To evaluate the results of rotational acetabular osteotomy （RAO） combined with debridement under arthroscope in the treatment Of adult developmental dysplasia of the hip （DDH）. Methods Between April 2002 and August 2007, 24 eases （29 hi ps） of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males （2 hips） and 22 females （27 hips） with an average age of 37.7 years （range, 21-50 years）. The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months （median, 30.5 months）. According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to T？nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes （range, 120-180 minutes）; the mean intraoperative blood loss was 600 mL （range, 500-700 mL）; and the mean postoperative drainage volume was 200 mL（range, 50-400 mL）. All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average （range, 3-8 years）. At last follow-up, daudication disappeared in 16 hips and was improved in 8 hips. The Harris hi p score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference （t=2.467, P=0.010）. The visual analogue scale （VAS） score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference （t=2.118, P=O.O 11 ）. The X-ray films showed union was achieved at 12-16 weeks （mean, 13.5 weeks）. There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation （P 〈 0.05）. Twenty hips at T？nnis stage I maintained after operation, among 9 hips at T？nnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult

关 键 词：髋臼发育不良 骨关节炎 髋臼周围旋转截骨术 关节镜 

分 类 号：R687.4[医药卫生—骨科学]