8岁以上儿童发育性髋关节脱位的术式选择及其近期疗效  

Treatment strategy and clinical outcome of developmental dislocation of the hip in children above 8 years old

作　　者：朱振华[1] 吕学敏[1] 边臻[1] 杨劼[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华骨科杂志》2014年第12期1175-1182,共8页Chinese Journal of Orthopaedics

基　　金：基金项目：北京市委组织部优秀人才培养专项经费资助项目（2010D003034000020）

摘　　要：目的探讨8岁以上儿童发育性髋关节脱位的术式选择及近期疗效。方法回顾性分析2006年1月至2012年12月手术治疗的8~13岁发育性髋关节脱位患儿94例112髋，男18例，女76例；年龄8．2-13．6岁，平均9．8岁。依据年龄将其分为8-9岁组、10~11岁组和12-13岁三组。髋关节脱位Tsnnis分型Ⅱ型34髋、Ⅲ型29髋、Ⅳ型49髋。全部病例均行髋关节切开复位、关节囊紧缩，股骨近端短缩去旋转截骨，髋臼侧采用Pemberton截骨66髋、Salter截骨30髋、伯尔尼髋臼周围截骨3髋、三联截骨5髋、Chiari骨盆内移截骨8髋。术后采用MeKay髋关节功能评价和Severin髋关节影像学评级对比不同年龄段、不同脱位程度组患儿治疗效果的差异。结果全部病例随访1-7年，平均2．3年。末次随访时MeKay髋关节功能为优22髋、良53髋、中32髋、差5髋，优良率67％（75／112）。（1）不同Tinnis分型组MeKay髋关节功能评级的差异有统计学意义，其中Ⅳ型组MeKay髋关节功能优良率低于Ⅱ型和Ⅲ型，而Ⅱ型和Ⅲ型之间的差异无统计学意义；不同Tonnis分型组Severin髋关节影像学评级的差异无统计学意义。（2）8~9岁组MeKay髋关节功能优于其他年龄组，12-13岁组Severin影像学评级较其他年龄组差。结论髋关节切开复位、股骨近端截骨及髋臼侧截骨是治疗大龄儿童发育性髋关节脱位的有效方法。手术疗效与切开复位时的年龄和脱位程度有关：TtinnisⅡ、Ⅲ型患儿术后髋关节功能优于Ⅳ型，年龄〈10岁的患儿术后髋关节功能和影像学评级较好。Objective To investigate the treatment and clinical outcomes in developmental dislocation of the hip in children above 8 years old. Methods We retrospectively reviewed the results of operation treatment for developmental dislocation of the hip in 94 children （112 hips） from 2006 to 2012. The age of the patients ranged from 8.2 to 13.6 years at the time of treatment, with an average age 9.8 years. In 94 patients, there are 18 males and 76 females. The patients were classified into three group based on the age at time of operation： Group 8-9 years old, Group 10-11 years old, Group 12-13 years old. The dislocation of hip was classified by Tonnis classification system： grade Ⅱ 34 hips, grade Ⅲ 29 hips, grade 1V 49 hips. Surgery was performed in all the patients. The procedures consisted of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proximal femur, and acetabular osteotomy which include Pemberton osteotomy （66 hips）, Salter osteotomy （30 hips）, Ganz osteotomy （3 hips）, Triple osteotomy （5 hips） and Chiari osteotomy （8 hips）. McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow-up was 2.3 years ranged from 1 to 7 years. According to McKay modified criteria at final follow-up, 75 hips （67%） had excellent （22 hips） and good （53 hips） clinical results, 32 hips （29%） were fair and 5 hips （4%） were poor. According to the Severin criteria, the outcomes of Tonnis grade IV group was significantly worse than Tonnis grade Ⅱ, Ⅲ group. There is no significant differences between Tonnis Ⅱ and m type groups. If the patients were classified by age at time of operation, the function of group 8-9 years old was significantly better than others group according to the McKay criteria; the group 12-13 years old was significantly worse than others group according to Severin criteria. Conclu- sion Open reduction with proximal femoral osteotomy and aeetabular osteotomy

关 键 词：髋脱位 先天性 儿童 截骨术 

分 类 号：R726.8[医药卫生—儿科]