切开复位、Salter骨盆截骨术治疗儿童发育性髋关节脱位的近期疗效评价  

Short-term efficacy evaluation of open reduction and Salter innominate osteotomy for the treatment of developmental dislocation of the hip in children

作　　者：丁晓飞[1] 苏柱程[1] 廖世杰[1] 陆荣斌[1] 赵劲民[1] 

机构地区：[1]广西医科大学第一附属医院创伤骨科手外科,广西南宁530021

出　　处：《中国矫形外科杂志》2013年第9期879-882,共4页Orthopedic Journal of China

摘　　要：[目的]评价切开复位、Salter骨盆截骨术治疗儿童发育性髋关节脱位术后的近期疗效。[方法]回顾性分析本组39例(43髋)发育性髋关节脱位患儿行切开复位、Salter骨盆截骨术后的基本资料。其中男7例,女32例;右髋7例,左髋28例,双髋4例。脱位程度按照Tonnis分级:Ⅰ度1髋,Ⅱ度11髋,Ⅲ度17髋,Ⅳ度14髋。测量髋臼指数(acetabular index,AI)、CE角(center-edge angle,CEA)和髋关节活动度,并在末次随访时,分别按Severin影像学评级标准和Mckay功能评级标准进行疗效评定。所有病例平均随访15.5个月。[结果]本组病例中,术后1髋出现半脱位,无股骨头缺血性坏死。末次随访时,AI平均22.6°,CEA平均29.1°,均较术前获得明显改善(P<0.05);患侧髋关节活动度基本恢复正常。按Severin标准评级,优良率为95.4%;按Mckay标准评级,优良率为93.0%;Severin标准影像学评级与Mckay标准功能评级间存在正相关,r=0.73(P<0.05)。[结论]切开复位、Salter骨盆截骨术后,脱位的股骨头能获得稳定的中心性复位,头臼包容改善并逐渐趋于正常。术后中短期的影像学改变与临床疗效具有一致性,影像学改变越满意,髋关节功能恢复越好。[ Objective] To evaluate the short- term clinical results of open reduction and Salter innominate osteotomy for the treatment of developmental dislocation of the hip in children. [ Methods ] A retrospective analysis of the clinical and radio- graphic data was made for 39 children （43 hips） who underwent open reduction and Salter innominate osteotomy for the treatment of developmental dislocation of the hip in our hospital. There were 7 boys and 32 girls. Seven hips were on the right side, 28 hips on the left side and 4 bilateral. According to Tonnis classification, 1 hip, 11 hips, 17 hips and 14 hips were respectively graded as I °, Ⅱ°, Ⅲ°and IV°. The following indices were studied： acetabular index （AI） , center - edge angle （CEA） and hip joint motion. The outcomes were evaluated by Severin classification system and Mckay classification system, and the correlation between them was analyzed in the latest follow - up. The patients were followed up for an average of 15.5 months with intact seri- al data. [ Results] After the operation, 1 hip had subluxation, but no hip appeared the sign of avascular necrosis of femur head. In the latest follow - up, the average of AI and CEA was 22. 6°and 29. 1°, respectively. Significant improvement in AI and CEA was observed in the latest follow - up （ P 〈 0. 05 ） . According to Severin radiographic classification, the execellent and good results rate was 94.7%. According to Mckay classification of the hip joint function, the execellent and good results rate was 93.0%. There was a significant correlation between Severin classification and Mckay classification, and the Spearman r was 0. 73 （P 〈 0. 05） . [ Conclusion] A stable concentric reduction was obtained after open reduction and Salter innominate oste- otomy, and the congruence of acetabulum and femoral head was improved to nearly normal levels gradually. The radiographic change is in accordance with the clinical effect. The more satisfied radiographic results was found, the more favorable

关 键 词：发育性髋关节脱位 SALTER骨盆截骨术 影像学改变 髋关节功能 儿童 

分 类 号：R726.8[医药卫生—儿科]