改良Sutherland截骨术治疗成人髋关节发育不良  

Treatment of developmental dysplasia of hip by modified Sutherland pelvic osteotomy

作　　者：马俊[1] 沈彬[1] 杨静[1] 黄强[1] 周宗科[1] 康鹏德[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华外科杂志》2011年第7期623-626,共4页Chinese Journal of Surgery

基　　金：基金项目：“十一五”国家科技支撑计划资助项目（2006BA116801）;国家863计划资助项目（2006AA02A135）

摘　　要：目的探讨改良Sutherland骨盆截骨术治疗成人髋关节发育不良的临床疗效。方法2002年7月至2008年8月应用改良Sutherland骨盆截骨术治疗10例（11髋）髋关节发育不良患者，男性3例3髋，女性7例8髋；平均年龄（32±8）岁。术中利用关节镜清理卵圆窝增生组织，修整代偿性肥厚的盂唇，确保股骨头与重新截骨定位的髋臼良好匹配。比较术前与术后的患髋影像学指标。比较术前与术后Harris及SF-12评分，了解患髋功能及患者生存质量的改变。结果全部患者随访（5．2±2．3）年，截骨处均在3个月内骨性愈合。头臼指数术前71±8，术后86±4；中心边缘角术前（7±9）°，术后（33±9）°；Sharp角术前（48±4）°，术后（37±5）°；臼顶倾斜角术前（24±8）°；术后（11±5）°；Harris评分术前42±13，术后90±5，优良率100％；手术前后比较差异均有统计学意义。SF-12中有关生存质量的8项评价术后均有不同程度的提高，躯体健康状况较精神健康状况提高明显。手术前后患髋影像学指标、Harris及SF-12评分差异均有统计学意义（P值均〈0．05）。结论改良Sutherland骨盆截骨术疗效确切，不仅改善了患者的生理功能，而且促进了患者心理、社会和自身健康感受等各方面的健康状况。Objective To investigate the clinical results of modified Sutherland pelvic osteotomy for developmental dysplasia of hip （ DDH）. Methods Sutherland pelvic osteotomy were performed in 10 patients （11 hips） with DDH. Among them, there were 3 male （3 hips） and 7 female （8 hips） patients, aged （32 ±8 ） years. During operation, arthroscopes were performed additionally to remove the existing hypewlasia tissue in the fossae ovalis and trimming acetabulum and glenoid labrum, thus to insure the better match between the femoral head and the realigned aeetabulum. The change of imaging indexes were acquired by comparing the preoperative X-ray with the postoperative X-ray. The change of hip function and life quality were acknowledged according to contrast and analysis Harris hip score and Short Form 12-items Health Survey （SF-12） before and after osteotomy. Results All patients were followed up for a mean of （5. 2 ± 2. 3） years, the osteotomy were all unioned in 3 months. The acetabular head index was 71 ± 8 before operation, and 86± 4 after operation. The pre- and post-operative centre edge angle were （7 ±9）° and （33±9）°, shaw angle were （48 ±4）° and （37 ±5）°, acetabular index angle were （24 ±8）° and （11 ±5 ）° respectively. The average Harris score improved from 42 ±13 preoperatively to 90 ± 5 postoperatively, with 100% excellent and good results. Every domains of SF-12 was improved in the different extents postoperatively, the improvement of physical component summary was more conspicuous than mental component summary. The imaging indexes, Harris and SF-12 were all improved with significant difference （ all P 〈 0. 05）. Conclusions The modified Sutherland pelvic osteotomy is effective. It could increase the load bearing capacity of hip, and improve the quality of life.

关 键 词：髋脱位 先天性 截骨术 关节镜检查 

分 类 号：R687.4[医药卫生—骨科学]