伯尔尼髋臼周围截骨术治疗髋关节发育不良的中长期疗效  

Mid- to long-term clinical outcome of Bernese periacetabular osteotomy in adolescents and young adults with developmental dysplasia of the hip

作　　者：程徽[1] 张洪[1] 罗殿中[1] 肖凯[2] 张辉良[2] 臧建成[2] 常红星[3] 张大光[4] 

机构地区：[1]中国人民解放军总医院第一附属医院关节外科,北京,100048 [2]天津医科大学研究生院 [3]北京军区总医院 [4]吉林大学第一医院骨关节外科

出　　处：《中华骨科杂志》2014年第12期1190-1197,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨伯尔尼髋臼周围截骨术治疗青少年和青壮年髋关节发育不良的中长期疗效及可能影响预后的因素。方法1997年8月至2009年7月采用伯尔尼髋臼周围截骨术治疗青少年及青壮年髋关节发育不良患者162例（177髋），其中有完整随访资料的123例（137髋）纳入研究。男30例33髋，女93例104髋；年龄12~48岁，平均27．1岁。术前及末次随访时行x线评价和Harris髋关节功能评估。于x线片上观察外侧cE角、臼顶倾斜（acetabular incline angle，AI）角、Shenton线的连续性，并采用Tannis骨关节炎分期对髋关节骨关节炎进行评估。结果于2014年6至7月进行集中随访，随访时间5~17年，平均8．1年。外侧CE角从术前7．13°±8．86°增加至30．17°±14．98°；AI角从术前27.84°±12．85°降低至7．06°±10．58°；Shenton线连续从术前87髋增加为106髋。Harris髋关节评分从术前（83．34±9．82）分增加至（92．79±7．05）分。术前Harris髋关节评分与末次随访时Harris髋关节评分具有相关性。术前Tonnis骨关节炎分期、Harris髋关节评分与末次随访时Harris髋关节评分中的疼痛评分具有相关性。15例（15髋）出现近期并发症，17例（17髋）在随访期间观察到骨关节炎进展。以全髋关节置换术为终点事件，末次随访时髋关节生存率为97．8％（134／137）。结论伯尔尼髋臼周围截骨术能够显著改善髋关节发育不良患者的髋关节骨性覆盖和髋关节功能。术后近期并发症发生率低，中远期出现骨关节炎进展的病例较少，关节生存率良好。术前Harris髋关节评分低及骨关节炎分期高是术后严重疼痛的预测因素。Objective To discuss the mid- to long-term resuhs and possible prognostic factors of Bernese periacetabu- lar osteotomy for adolescents and young adults with developmental dysplasia of the hip. Methods Bernese periacetabular os- teotomy was performed on 162 patients （171 hips） with hip dysplasia from August 1997 to July 2009. Follow-up data was ac- quirable completely in 123 cases （137 hips）, including 30 males （33 hips） and 93 females （104 hips）. Age of surgery was 12- 48 years （average 27.1 years）. The X-ray radiographs and Harris scores were recorded preoperatively and at the last follow-up. The lateral center-edge angle （LCE）, acetabular incline angle （AI）, continuity of Shenton＇s line were also recorded. The grades of the hip osteoarthritis were classified by Tonnis classification. Insufficient corrections of osteotomy, excessive corrections of osteotomy, nonunion of the pubis, nerve injuries, and vascular injuries were recorded as complications. Results All the con- tactable cases was followed up again in June and July in 2014. Follow-up duration was 5-17 years （mean, 8.1 years）. The LCE angle improved from 7.13°±8.86° preoperatively to 30.17°±14.98° at the final follow-up. The Tonnis acetabular incline angle decreased from 27.84°±12.85° preoperatively to 7.06°±10.58° at the final follow-up. The continuity of Shenton＇s line was in- tact in 106 cases postoperatively, compared with 87 cases preoperatively. Harris score improved from 83.34±9.82 preoperative- ly to 92.79±7.05 at the last follow-up. There was significant correlation between preoperative Harris score and Harris score at the last follow-up. Early complications were observed in 15 cases （15 hips）, along with 17 cases （17 hips） of progressions of hip osteoarthritis. Survival rate of the hip at the last follow-up was 97.8%. Conclusion Bernese periacetabular osteotomies can significantly improve bone coverage and joint function of hip dysplasia patients with low rate of short-term complications

关 键 词：髋脱位 先天性 骨关节炎 髋 截骨术 成年人 青少年 

分 类 号：R687.4[医药卫生—骨科学]