Y形截骨术治疗儿童发育性髋内翻的疗效观察  

EFFECTIVENESS OF Y-SHAPED OSTEOTOMY FOR DEVELOPMENTAL COXA VARA IN CHILDREN

作　　者：阿布力孜·吐尔送[1] 李国庆[1] 阿斯卡尔·买买提明[1] 曹力[1] 

机构地区：[1]新疆医科大学第一附属医院骨科中心关节外科乌鲁木齐,830011

出　　处：《中国修复重建外科杂志》2013年第6期649-652,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30860287)~~

摘　　要：目的探讨Y形截骨术治疗儿童发育性髋内翻的疗效。方法 2008年1月-2011年10月,收治10例14髋儿童发育性髋内翻。男4例5髋,女6例9髋;年龄5～12岁,平均7.8岁。患儿均有明显跛行步态,髋部外展、内收、旋转受限。摄骨盆正位X线片,测量颈干角为46～110°,平均87°;双髋Y形软骨的Hilgenriener线与股骨上干骺端骺板线的夹角(Hilgenreiner-epiphyseal angle,HE)为36～93°,平均57°;股骨头最高点平面与股骨大粗隆顶点平面间距离(articulotrochanteric distance,ATD)为—25～6 mm,平均—3 mm。采用股骨粗隆下股骨外侧Y形截骨矫形,联合外展截骨角钢板内固定。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患儿均获随访,随访时间14～40个月,平均18个月。患儿跛行步态消失或明显减轻,髋关节外展、内收、旋转活动范围均不同程度增大。术后复查X线片示,垂直的股骨近端骺板均恢复至水平位置,患髋颈干角为130～153°,平均137°;HE角为23～35°,平均27°;ATD为3～22 mm,平均14 mm。末次随访时,根据刘建德的疗效评价标准评定,获优5髋,良8髋,可1髋;优良率达92.8%。除1例于术后30个月髋内翻畸形复发,其余患儿均无复发。结论 Y形截骨术治疗儿童发育性髋内翻具有截骨方法简便,矫形充分,术后允许早期活动的优点,可获得满意临床疗效。Objective To investigate the effectiveness of Y-shaped osteotomy for treatment of developmental coxa vara in children.Methods Between January 2008 and October 2011,10 cases（14 hips） of developmental coxa vara were treated.There were 4 boys（5 hips） and 6 girls（9 hips）,aged 5-12 years（mean,7.8 years）.All the children had obvious lameness and limitations of hip abduction,adduction,and rotation.The anteroposterior pelvic X-ray films showed that the collodiaphysial angle ranged from 46 to 110°（mean,87°）;Hilgenreiner-epiphyseal angle（HE） ranged from 36 to 93°（mean,57°）;and the articulotrochanteric distance（ATD） ranged from —25 to 6 mm（mean,—3 mm）.The subtrochanteric Y-shaped osteotomy was performed and angle steel plate was used for internal fixation.Results All incisions healed by first intention without surgery-related complication.All cases were followed up 14-40 months（mean,18 months）.The symptom of lameness disappeared or obviously alleviated;the range of motion of hip abduction,adduction,and rotation were increased.Postoperative X-ray films showed that the vertical epiphyseal plate of proximal femur was returned to the horizontal.After operation,the collodiaphysial angle was 130-153°（mean,137°）;HE angle was 23-35°（mean,27°）;and the ATD was 3-22 mm（mean,14 mm）.According to LIU Jiande＇s assessment standards,the results were excellent in 5 hips,good in 8 hips,and fair in 1 hip,and the excellent and good rate was 92.8%.The other children had no recurrence of coxa vara except 1 case after 30 months.Conclusion The Y-shaped osteotomy is a simple and effective method to treat developmental coxa vara in children,which can fully correct the deformity,and patients can exercise early because of firm internal fixation.

关 键 词：发育性髋内翻 Y形截骨术 外展角钢板 儿童 

分 类 号：R726.8[医药卫生—儿科]