18个月到3岁发育性髋关节脱位患儿初次开放复位股骨截骨与不截骨近期疗效的比较研究  

Short-term efficacies of femoral osteotomy for developmental dislocation of the hip in children

作　　者：何金鹏[1] 梅海波[2] 徐宏文 郭跃明[4] 唐盛平[5] 蒋飞[6] 陈顺有[7] 李进[8] 邵景范[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030 [2]湖南省儿童医院骨科 [3]广州市妇女儿童医疗中心骨科 [4]佛山市中医院小儿骨科 [5]深圳市儿童医院骨一科 [6]大连医科大学附属大连市儿童医院骨科 [7]厦门大学附属福州第二医院儿童骨科 [8]华中科技大学同济医学院附属协和医院骨科

出　　处：《中华小儿外科杂志》2016年第12期888-892,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨股骨是否截骨对18个月～3岁儿童发育性髋关节脱位（developmental dislocation of the hip，DDH）开放复位手术治疗的近期疗效有无影响。方法回顾性研究2010年1月至2013年12月间在国内8家单位行开放复位手术治疗的18个月～3岁的67例DDH患儿中，股骨截骨组（41例）与股骨不截骨组（26例）的近期疗效有无差异，评估术后髋臼指数（acetabular index，AI）变化，股骨头缺血性坏死（avascular necrosis，AVN）率及髋关节再脱位率有无差异。结果股骨截骨组41例，平均年龄（2．27±0．46）岁；术后2年内复查X线发生AVN5例，均为Bucholz-Ogden Ⅰ型，发生髋关节再脱位3例。股骨不截骨组26例，平均年龄（1．99±0．38）岁；术后2年内复查x线发生AVN3例，均为Bucholz-Ogden Ⅰ型，发生髋关节再脱位1例。其他并发症有医源性骨折1例，为截骨组患儿；髋关节僵硬1例，为股骨不截骨组患儿；跛行6例，股骨截骨组3例、不截骨组3例。两组间术前AI、年龄、性别构成及脱位程度等指标差异均无统计学意义（P〉0．05）。股骨截骨组开放复位术后复查AI平均（20．57±6．89）度，股骨不截骨组为（24．21±7．20）度，组间差异有统计学意义（P〈0．05）；但两组术后1年及2年AI差异均无统计学意义（P〉0．05）。结论回顾性研究提示18个月～3岁DDH患儿行开放复位手术时股骨是否截骨对于术后AI的改善情况、近期AVN及髋关节再脱位率没有显著影响。因此，18个月～3岁DDH儿童行开放复位手术时推荐不常规应用股骨截骨术以减少手术创伤，但应综合术中复位难易情况考虑。Objective To explore the short-term efficacies of femoral osteotomy for open reduction of developmental dislocation of the hip （DDH）. Methods A retrospective study of 67 DDH patients were conducted between January 2010 and December 2013. Forty-one patients were assigned into group Ⅰ with femoral osteotomy and another 26 into group II without femoral osteotomy. The parameters of acetabular index （AI）, avascular necrosis （AVN） and recurrent subluxation rate were analyzed. Results In group Ⅰ , the average age was （2. 27 ± 0. 46） years, 5 hips developed Bucholz- Ogden type Ⅰ AVN and subluxation recurred in 3 hips. In group Ⅱ , the average age was （1.99 ± 0. 38） years, 3 hips developed Bucholz-Ogden type Ⅰ AVN and subluxation recurred in 1 hip. There was 1 case of iatrogenic fracture in 1 hip in group Ⅰ and joint stiffness occurred in 1 hip in group Ⅱ. There were 3 hips with claudication in each group. No significant inter-group differences existed in age, gender, dislocation degree, preoperative AI, 1-year postoperative AI and 2-year postoperative AI （P〉0. 05）. Postoperative AI was obviously smaller in group I than that in group Ⅱ （20. 57° ± 6. 89° vs 24. 21° ± 7. 20°, P〈0. 05）. Conclusions Femoral osteotomy is not required for DDH children undergoing reduction at 18-36 months. Such a decision should be made on the basis of hip stability.

关 键 词：髋关节脱位 截骨术 股骨 

分 类 号：R726.8[医药卫生—儿科]