Pemberton骨盆截骨术联合股骨近端截骨治疗儿童期发育性髋关节脱位疗效分析  

Efficacy analysis of Pemberton acetabuloplasty and proximal femur osteotomy in children with developmental dysplasia of hip

作　　者：韦宜山[1] 刘万林[1] 赵振群[1] 李岱鹤[1] 白锐[1] 

机构地区：[1]内蒙古医科大学第二附属医院小儿骨科,呼和浩特010030

出　　处：《中华小儿外科杂志》2015年第7期501-505,共5页Chinese Journal of Pediatric Surgery

基　　金：内蒙古自治区教育厅高等学校科学技术研究项目（NJ05130）

摘　　要：目的探讨Pemberton骨盆截骨术联合股骨近端个体化截骨治疗儿童期发育性髋关节脱位的中长期临床疗效。方法2004年8月至2006年10月间对38例（49髋）儿童期（3～8岁）发育性髋关节脱位实施Pemberton骨盆截骨术联合股骨近端短缩、内翻、去旋转个体化截骨，术前年龄（5．42±2．60）岁，Tonnis分级Ⅱ度9髋，Ⅲ度11髋，Ⅳ度29髋。结果术后随访（7．73±1．64）年，采用TraumaCAD软件测量骨性髋臼指数从术前（41．62±10．80）°恢复到（6．62±3．76）°，中心边缘角从（-56．80±66．14）。恢复到（34．34±6．63）°，Reimers不稳定指数从（71．30±33．26）％恢复到（13．22±12．15）％，平均值恢复到正常范围，Mckay髋关节功能优良率81．63％，Severin影像学优良率73．47％，并且两者评级间存在正相关（r=0．62，P〈0．05）。末次随访发生半脱位4髋。结论保持头臼同心圆复位和重视关节囊紧缩缝合以及降低股骨头坏死率是Pemberton骨盆截骨术联合股骨近端截骨治疗儿童期发育性髋关节脱位术后疗效满意的关键。Objective To explore the medium and long-term outcomes of adopting Pemberton acetabuloplasty and proximal femur individualized osteotomy for treastment of developmental dysplasia of the hip （DDH） in children. Methods Between August 2004 and October 2006, 38 DDH patients （49 hips） aged 3-8 years underwent Pemberton aeetabuloplasty and proximal femoral subtroehanteric shortening, varus and derotation individualized osteotomy. Their average preoperative age was （5.42 ±2. 60） years. Based upon the Tonnis classification, the grades were Ⅱ ° （n= 9）, Ⅲ° （n= 11） and Ⅳ° （n = 29） respectively. Results The follow-up period was （7. 73 ±1.64） years. Comparing preoperative with the last follow-up, bony acetabular index, as measured by Trauma CAD Software, recovered from （41.62 ± 10. 80）° to （6. 62 ±3.76）°, center-edge angle from （ - 56. 80 ±66. 14） to （34. 34±6. 63） and Reimers index from （71.30 ±33.26）% to （13. 22 ±12. 15）%. And the average values were restored to the normal range. The good rate of hip function was 81.63% according to the Mckay clinical criteria for assessing hip function. The good rate of imaging was 73. 47% aecording to the Severin radiographic classification. There was significant correlation between Mckay and Severin classifications. And Spearman＇s r was 0. 62 （P〈0. 05）. At the last follow-up, 4 hips had subluxation. Conclusions Maintaining concentric reduction of femoral head and acetabulum, stressing joint capsule tightening suture and reducing necrosis rate of femoral head are the key aspects for achieving successful outcomes for Pemberton acetabuloplasty and proximal femur individualized osteotomy in the treatment of pediatric DDH.

关 键 词：髋脱位 截骨术 股骨 

分 类 号：R726.8[医药卫生—儿科]