Salter截骨术与Pemberton截骨术治疗2～3岁发育性髋关节脱位的疗效分析  

Open reduction combined with Salter or Pemberton osteotomy and proximal femoral osteotomy for the management of developmental dislocation of the hip in children between the ages of 2 and 3 years

作　　者：边臻[1] 朱振华[1] 郭源[1] 张建立[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》2015年第9期935-941,共7页Chinese Journal of Orthopaedics

摘　　要：目的比较Saher截骨术与Pemberton截骨术治疗2-3岁发育性髋关节脱位（developmental dislocation of the hip，DDH）患儿的手术疗效。方法回顾性分析1998年1月至2008年12月接受Salter截骨术或Pemberton截骨术治疗的DDH患儿59例（84髋），男10例（14髋），女49例（70髋）；年龄2-3岁，平均（2．5±0．4）岁。全部病例行髋关节切开复位、骨盆Salter截骨或Pemberton截骨、股骨近端旋转短缩截骨术。术后采用McKay髋关节功能评价评估临床疗效，影像学评价采用Severin髋关节评级，统计两种截骨术Severin髋关节评级优良率和术后相关并发症的发生率。结果全部病例随访2～16年，平均（5．6±3．5）年。末次随访影像学Severin髋关节评级优58髋、良20髋、中4髋、差2髋，优良率为93％（78／84），其中Salter截骨术组优良率100％，Pemberton截骨术组优良率82％，差异有统计学意义（x^2=7．43，P=0．003）。末次随访时McKay髋关节功能评价满意率Salter截骨术组（100％）与Pemberton截骨术组（97％）的差异无统计学意义（x^2=1．56，P=0．39）。Pemberton组1例发生髋关节半脱位及早期退行性变，其余病例效果优良。18髋（21％，18／84）发生了程度不同的股骨近端发育障碍，其中Pemberton截骨术组10髋、Salter截骨术组8髋，两组股骨近端发育障碍发生率的差异无统计学意义（x^2=2．54，P=0．17）。结论髋关节切开复位、骨盆Salter截骨或Pemberton截骨、股骨近端旋转短缩截骨术是治疗2-3岁DDH患儿的有效方法，但采用Pemberton截骨术时应注意避免出现由于髋臼外缘吸收而导致的髋臼发育不良。Objective The objective was to discussing the difference between the Pemberton osteotomy and Salter osteotomy which performed in patients between the ages of 2 and 3 years who suffered from developmental dislocation of the hip （DDH）. Methods A retrospective review of the results of operation treatment for DDH in 59 children （84 hips） from January 1998 to December 2008 was conducted. There are 10 boys （14 hips） and 49 girls （70 hips）. The age of the patients was between 2-3 years old at the time of treatment＇2.5±0.4 years. Surgery consist of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proximal femur, and innominate osteotomy which include Pemberton osteotomy （33 hips）, Salter osteotomy （51 hips）. McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow-up time was 5.6±3.5 years ranging from 2 to 16 years. According to Severin criteria at final follow-up, 78 hips （93%） had excellent and good results; 4 hips were fair and 2 hips poor result. The radiology results in Salter osteotomy were better than Pemberton osteotomy （rate of excellent and good results 100% vs. 82%, x^2=7.43, P=0.003）. According to the McKay criteria Salter osteotomy and Pemberton osteotomy have no significant difference in latest follow-up （the satisfactory rate 100% vs. 97%,x^2=1.56, P= 0.39）. 18 hips （21%） had proximal femoral growth disturbance which 10 hips in Pemberton group, 8 hips in Salter group. There is no significant difference （x^2=2.54, P=0.17）. Conclusion Open reduction, innominate osteotomy and proximal femoral osteotomy were effective procedures for the treatment of DDH in children between 2-3 years old. More attention should be taken in Pemberton osteotomy to prevent the acetabular bony edge absorption.

关 键 词：髋脱位 先天性 截骨术 股骨头坏死 

分 类 号：R687.3[医药卫生—骨科学]