影响Pemberton手术治疗发育性髋关节脱位的多因素分析  

Analysis on multifactors affecting Pemberton acetabuloplasty for treating developmental dysplasia of hip

作　　者：周士铭[1] 李明[1] 王海[1] 郑超[1] 翁刘其[1] 周海[1] 

机构地区：[1]重庆医科大学附属儿童医院骨科中心,重庆400014

出　　处：《现代医药卫生》2011年第21期3209-3211,共3页Journal of Modern Medicine & Health

摘　　要：目的：探讨Pemberton手术治疗儿童发育性髋关节脱位（Developmental Dysplasia of the Hip,DDH）,髋臼指数（acetabularindex,AI）、前倾角、颈干角及关节囊等因素对手术治疗的影响。方法：回顾性分析2006~2010年采取Pemberton手术治疗DDH 82例（98髋）,术前双侧髋关节行薄层平扫及3D重建测量AI、前倾角（femoral neck anteversion,FNA）及颈干角（collodiaphyseal angle,CDA）,指导术中行旋转截骨、造盖术及适当修整关节囊并行关节囊紧缩术,术后复查患儿AI、FNA及CDA,并随访12~48个月。结果：82例患儿得到随访,随访时间12~48个月,平均34个月。根据Mckay髋关节功能评分标准进行评价,优76髋（77.55%）,良16髋（16.32%）,可6髋（6.12%）,差0髋（0%）,AI平均缩小（17.5±0.7）度,FNA平均缩小（13.8±3.7）度,CDA平均缩小（13.0±3.5）度,采取SPSS17.0数据处理系统进行统计分析（t检验）,术后患侧的AI、FNA、CDA与术前相比差异均极有统计学意义（t〉t0.01,97,P〈0.01）。结论：对于儿童DDH行Pem-berton手术治疗,AI、FNA、CDA及关节囊是影响治疗效果的四个重要方面,AI、FNA的矫正有利于髋臼成形及维持髋关节稳定,CDA的矫正则有利于增加髋臼对股骨头的包容度,术中视关节囊具体情况适当的进行关节囊修整重建、紧缩术非常重要,对于股骨头的复位尤其是防止术后再脱位有重要作用。Pemberton手术治疗时常会涉及到其中的一个或全部,因此,术前准确评估,术中精确操作,对任何一方面的矫正适当与否均关系到术后疗效。Objective：To evaluate the influence of acetabular index（AI）,femoral neck anteversion（FNA）,collodiaphyseal angle（CDA） and articular capsule（AC） on Pemberton acetabuloplasty for treating developmental dysplasia of hip（DDH）.Methods：82 children with DDH（24 hips in 18 boys and 74 hips in 64 girls,aged 6~14 years,average 8.5 years） treated by Pemberton acetabuloplasty and followed up for 12~48 months（average 34 months） from 2006 to 2010 were performed the retrospective analysis.Before operation,AI,FNA and CDA were evaluated by thin slice hip joint scan and 3D reconstruction to direct the rotary osteotomy,shelf operation and contraction of articular capsule during surgery.After operation,AI,FNA and CDA were rechecked.Results：All the patients were followed up for 12-48 months,average 34 months.The clinical assessment was performed according to Mckay′ s classification.The results showed excellent in 76 hips（77.55%）,good in 16 hips（16.32%）,acceptable in 6 hips（6.12%） and poor in 0 hip（0%）.AI was decreased by average 17.5°±0.7°,FNA decreased by average 13.8°±3.7° and CDA decreased by average 13.0°±3.5°.The data were analyzed by SPSS17.0 with t test,AI,FNA and CDA had significant difference compared with those before surgery（tt0.01,97,P0.01）.Conclusion：AI,FNA,CDA and articular capsule are the four most important aspects affecting the effects of Pemberton acetabuloplasty for treating DDH.The rectification of AI and FNA is helpful for forming and stabilization of the hip joint.The rectification of CDA is helpful to increase the coverage of acetabulum to femoral head.Shelf operation and contraction of articular capsule are necessary according to the condition of articular capsule,as it is important for capital replacement especially the prevention of redislocation of the hip.Pemberton acetabuloplasty usually involves some or all of the aspects above.Any one will affect the postoperative effects.

关 键 词：发育性髋关节脱位 PEMBERTON手术 髋臼指数 前倾角 颈干角 关节囊 

分 类 号：R6[医药卫生—外科学]