改良Salter骨盆截骨术治疗幼儿发育性髋关节脱位  

Modified Salter pelvic osteotomy for developmental dislocation of the hip in early children

作　　者：李天友[1] 李龙[1] 刘帅[1] 王恒冰[1] 张敏刚[1] 王延宙[1] LI Tian-you;LI Long;LIU Shuai;WANG Heng-bing;ZHANG Min-gang;WANG Yan-zhou(Department of Pediatric Orthopedics,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院小儿骨科,济南250021

出　　处：《中国矫形外科杂志》2019年第1期5-10,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81501844);中国博士后科学基金项目(编号:2017M612285);山东省自然科学基金项目(编号:BS2015YY009)

摘　　要：[目的]介绍改良Salter骨盆截骨术,随访其治疗幼儿发育性髋关节脱位的短期临床效果。[方法]回顾性分析2013年7月～2015年12月本院采用切开复位联合改良Salter骨盆截骨术治疗幼儿发育性髋关节脱位的病例资料,纳入患儿共30例(30髋),均为单侧髋关节全脱位,其中男2例,女28例,年龄13～24个月,平均(18.57±2.66)个月;左侧19髋,右侧11髋。记录手术时间、髋臼指数、临床功能恢复情况及再脱位、股骨头缺血性坏死等并发症情况。[结果]所有病例手术时间50～75 min,平均(60.23±8.76) min,无血管、神经损伤等严重术中并发症。术中失血约10～30 ml,平均(21.17±6.91) ml,均未输血。除1髋术后1 d再脱位,经更换石膏后复位良好外,其他患儿均达到同心复位。髋臼指数由术前(38.03±6.27)°减少至术后(28.49±5.63)°,平均矫正[(9.75±7.31)°,95%CI (7.11～12.28)°]。随访16～46个月,平均(28.33±7.57)个月,随访期间3髋(10.00%)发生I型股骨头缺血性坏死。末次随访时,按照改良Mckay临床功能评定标准,优26髋(86.67%),良4髋(13.33%),优良率100.00%。在影像方面,所有病例手术侧均无再脱位,均未发生髂骨翼畸形,手术侧髋臼指数随时间延长进一步改善,与非手术侧相等,甚至优于对侧,因为非手术侧有8髋髋臼发育不良。[结论]改良Salter骨盆截骨术微创优效,有助于加速髋关节脱位的髋臼重塑,减少残余髋臼发育不良的发生。[Objective] To introduce a modified Salter pelvic osteotomy, and to explore the short-term clinical outcome for developmental dislocation of the hip(DDH). [Methods] A retrospective study was done on 30 children(30 hips) who underwent the modified Salter osteotomy for unilateral total hip dislocation due to DDH from July 2013 to December 2015. The patients, including 2 boys and 28 girls, aged from 13 to 24 months with an average of(18.57±2.66) months, involving 19 left hips and 11 right hips. The operation time, functional recovery and radiographic assessment, such as reduction quality, redislocation, acetabular index and femoral head necrosis, were evaluated. [Results] The children had operation performed for 50 to 75 mins with a mean of(60.23±8.76) mins, with no serious complications, such as neurovascular injuries, in any of them. The intraoperative blood loss ranged from 10 to 30 ml approximately with an average of(21.17±6.91) ml, and no blood transfusion needed in anyone of the children. Except one child who got redislocation at 1 day postoperatively, which regained concentric reduction by plaster cast changed, all the children achieved concentric reduction of the affected hips. Correspondingly, the acetabular index significantly decreased from(38.03±6.27)° preoperatively to(28.49±5.63)° postoperatively(P<0.05), associated with a corrective decrement of [(9.75±7.31)°, 95%CI(7.11~12.28)°]. All the children were followed up for 16 to 46 months with an average of(28.33±7.57) months. During the follow-up, 3 hips(10.00%) were proved type I femoral head necrosis. At the latest follow (86.67%) and good in 4 hips(13.33%) based on Mckay criteria, associated with excellent and good rate of 100.00%. In term of radiographic assessment, no redislocation and no iliac deformity were observed on the operated side in any of children, whereas the acetabular indexes of operated sides significantly improved over time to be equal, even superior to the unoperated sides due to 8 unoperated hips with acetabular dysplasia.

关 键 词：发育性髋关节脱位 SALTER骨盆截骨术 残余髋臼发育不良 

分 类 号：R684.3[医药卫生—骨科学]