固骼生联合自体髂骨在发育性髋关节脱位患儿行髋臼截骨术中的应用  

The effect of NovaBone combined with autologous iliac in the acetabular osteotomy of children with developmental dislo-ation of the hip

作　　者：赵雄[1] 马益善[1] 陆清达 雷伟[1] 颉强[1] 

机构地区：[1]第四军医大学西京医院骨科,西安710032

出　　处：《中华骨科杂志》2015年第1期62-67,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助面上项目（81472043）

摘　　要：目的比较单纯应用自体髂骨植骨与联合应用固骼生植骨对发育性髋关节脱位（developmentaldislocationofthehip，DDH）患儿行髋臼截骨术的临床效果。方法回顾性分析2007年3月至2011年10月采用切开复位髋臼截骨术治疗的113例DDH患儿资料。根据髋臼截骨术后使用的植骨材料，分为自体髂骨植骨组（52例，60髋）与固骼生联合自体髂骨植骨组（61例，67髋）。113例患儿髋关节Tonnis脱位分级均为Ⅱ-Ⅳ度。两组患儿性别、年龄、手术侧别、脱位分型、髋臼截骨方式及髋臼指数比较，差异均无统计学意义。分别于术后6周、3个月、6个月、1年与2年进行随访，分别比较两组患儿髋臼截骨区骨愈合情况、髋关节的影像学及功能恢复情况，并采用Lane、Sevefin及McKay标准进行评分。结果术后6周与术后3个月时Lane骨愈合评分，联合固骼生组分别为（6．4±1．3）分、（9．6±1．7）分，自体髂骨组分别为（4．7±1．5）分、（7．8±1．2）分，前者骨愈合情况明显优于后者，两组之间有差异；而术后6个月与术后1年时，联合固骼生组和自体髂骨组截骨区均基本达到骨性愈合，两组无差异。Severin标准髋关节影像学评价结果显示：联合固骼生组（优41髋、良22髋、可4髋）优良率为（94．0％，63／67）明显高于自体髂骨组（优28髋、良22髋、可10髋）的优良率（83．3％，50／60）；自体髂骨组可的概率（16．7％，10／60）明显高于联合固骼生组（6．0％，4／67）。McKay标准髋关节功能评价结果与影像学评价结果一致。结论固骼生作为一种新型的骨缺损修复材料，能在术后早期促进髋臼截骨区骨愈合，从而提高截骨区域抗压性。在DDH患儿行髋臼截骨术中联合应用固骼生植骨可以辅助获得满意的头臼对位关系及髋关节功能。Objective To compare the effect of application of autologous iliac alone and NovaBone combined with autolo- gous iliac in the acetabular osteotomy of children with developmental dislocation of the hip （DDH）. Methods Data of 113 cases of children with DDH who had undergone open reduction and acetabular osteotomy surgery from 2007 to 2011 were retrospectively analyzed. According to bone material using after acetabular osteotomy, the patients were divided into autogenous iliac bone graft group （52 cases, 60 hips） and NovaBone combined with autologous iliac bone graft group （61 cases, 67 hips）. There were no statisti- cal differences in gender, age, side, dislocation type, osteotomy and acetabular index between the two groups. The patients were evaluated by Lane＇s scoring criteria, Severin standards and McKay standards at 6 weeks, 3 months, 6 months, 1-year and 2-year post-operation follow-up. The bone healing of acetabular osteotomy zone, radiography and function of hip were compared. Results 6 weeks and 3 months after operation, Lane bone healing score in NovaBone combined with autologous iliac bone graft group （6.4± 1.3 points and 9.6± 1.7 points respectively） was obviously superior to autogenous iliac bone graft group （4.7±1.5 points and 7.8±1.2 points respectively）. And 6 months and 1 year after operation, the two groups were basically reached bone healing. The Severin standard results showed that the rate （94%, 63/67） of ＂Excellent and Good＂ in NovaBone combined with autologous iliac bone graft group （excellent： 41 hips, good： 22 hips, Fair： 4 hips） was significantly higher than the rate （83.3%, 50/60） in autogenous iliac bone graft group （excellent： 28 hips, good： 22 hips, Fair： 10 hips）. The rate （16.7%, 10/60） of ＂Fair＂ in autogenous iliac bone graft group was significantly higher than the rate （6.0%, 4/67） in NovaBone combined with autologous iliac bone graft group. McKay standard results were consistent with the results of radiological e

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]