髋臼旋转截骨术及Chiari截骨术对发育性髋关节发育不良生物力学影响的比较研究  

COMPARATIVE STUDY ON BIOMECHANICAL EFFECTS BETWEEN ROTATIONAL ACETABULAR OSTEOTOMY AND Chiari OSTEOTOMY IN DEVELOPMENTAL DYSPLASIA OF HIP

作　　者：傅明[1] 张志奇[1] 向珊珊[2] 刘进[1] 黄广鑫[1] 

机构地区：[1]中山大学附属第一医院关节外科广州,510080 [2]中山大学附属江门医院骨外科

出　　处：《中国修复重建外科杂志》2013年第6期641-644,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金面上项目(81171759、81201388);广东省科技计划资助项目(2011B031300012)~~

摘　　要：目的通过生物力学测试,比较髋臼旋转截骨术及Chiari截骨术治疗成人发育性髋关节发育不良(developmental dysplasia of the hip,DDH)后对髋关节生物力学的影响。方法取8具成年女性骨盆标本,切除双侧髋关节髋臼后沿和上沿,使其股骨头中心点垂线与髋臼外侧边缘夹角<20°,制备DDH模型;然后于左侧行髋臼旋转截骨术,右侧行Chiari截骨术。分别对正常标本、DDH模型及两种截骨术后标本,于材料试验机上以5 mm/min速率加载至600 N测量髋关节应变值。结果正常标本左、右侧髋关节应变值分别为845.63±533.91及955.94±837.42;DDH模型应变值明显增加,左、右侧分别为1 439.03±625.23及1 558.75±1 009.46,约为正常标本的2倍。结合形态学、影像学检查,提示DDH模型制备成功。髋臼旋转截骨术后髋关节应变值为574.94±430.88,较DDH模型明显下降,差异有统计学意义(t=4.176,P=0.004)。Chiari截骨术后髋关节应变值为1 614.81±932.67,与DDH模型相似,差异无统计学意义(t=0.208,P=0.841)。髋臼旋转截骨术后髋关节应变值与术前应变值之差显著低于Chiari截骨术,差异有统计学意义(t=—2.548,P=0.023)。结论髋臼旋转截骨术缓解DDH髋关节病理性应力的效果优于Chiari截骨术。Objective To compare the biomechanical effects between rotational acetabular osteotomy and Chiari osteotomy for developmental dysplasia of the hip （DDH） by biomechanical test. Methods Sixteen DDH models of 8 human cadaver specimens were prepared by resecting the upper edge and posterior edge of acetabulum. And the Wiberg central-edge angle （CE） of the DDH model was less than 20~. Then the rotational acetabular osteotomy was performed on the left hip and Chiari osteotomy on the right hip. When 600 N loading was loaded at S mm/minute by a material testing machine, the strain values of normal specimens, DDH specimens, and 2 models after osteotomies were measured. Results In normal specimens, the strain values of the left and right hips were 845.63 ±533.91 and 955.94 ± 837.42 respectively, while the strain values were 1 439.03 ±625.23 and 1 558.75 ± 1 009.46 respectively in DDH specimens, which was about 2 times that of normal hips. The morphology and X-ray examinations indicated that the DDH model was successfully established. The strain value was 574.94 ±430.88 after rotational acetabular osteotomy, and was significantly lower than that of DDH specimens （t=4.176, P--0.004）; the strain value was 1 614.81±932.67 after Chiari osteotomy, showing no significant difference when compared with that of DDH specimens （t=0.208, P=0.841）. The strain value relieved by rotational acetabular osteotomy was significantly higher than that by Chiari osteotomy （t=2.548, P=0.023）. Conclusion Rotational acetabular osteotomy is better than Chiari osteotomy in relieving hi p joint stress of DDH.

关 键 词：发育性髋关节发育不良 髋臼旋转截骨术 CHIARI截骨术 髋关节应力 

分 类 号：R687.4[医药卫生—骨科学]