髋臼成形术联合髋臼周围旋转截骨治疗大龄儿童发育性髋关节发育不良的早期效果  

Combined procedure of acetabularplasty and periacetabular osteotomy in treatment of developmental dysplasia of the hip in older children

作　　者：吕学敏[1] 傅刚[1] 杨劼[1] 朱振华[1] 王玉琨[1] 郭源[1] 

机构地区：[1]北京积水潭医院小儿骨科,北京100035

出　　处：《骨科临床与研究杂志》2017年第1期30-36,共7页Journal Of Clinical Orthopedics And Research

基　　金：北京市医管局"扬帆计划"临床创新项目(XM201405)~~

摘　　要：目的探讨髋臼成形术联合髋臼周围旋转截骨手术治疗9岁以上儿童发育性髋关节发育不良的可行性及其早期效果。方法回顾2010年10月至2016年1月就诊于北京积水潭医院小儿骨科行髋臼成形术联合髋臼周围旋转截骨手术的患儿7例。详细介绍手术方法,分析手术适应证,采用Severin分级和Mc Kay评分评价方法对手术后髋关节的X线表现及功能进行分析和评价。结果本研究组病例平均年龄9.9岁(9~11岁),均为女性,术前Tonnis分型为Ⅲ~Ⅳ型,随访时间最长67个月,最短6个月,平均16个月。7例患儿中6例除髋臼侧手术外同时行股骨近端截骨,1例除本研究所描述的手术方式外未行股骨近端截骨手术。截至随访期,未出现股骨头再脱位和股骨头缺血坏死等术后并发症,Mc Kay评分1例优、2例良、4例中,Severin髋关节分级均为Ⅱ型。结论处理9岁以上大龄儿童发育性髋关节发育不良髋臼侧的病理改变时,髋臼成形术联合髋臼周围截骨可以作为一种选择方案。对其早期效果评价,本研究组病例髋关节功能均达Mc Kay分级中以上,髋关节影像学结果均可达良好。Objective To explore the possibility and early outcome of the combined procedure of ace- tabularplasty and periacetabular osteotomy in treatment of developmental dysplasia of the hip in older children. Methods Seven cases from Oct 2010 through Jan 2016 who underwent the combined procedure were reviewed. The detailed surgical method was introduced and the indication for the procedure was analysed. We used modi-fied McKay classification and Severin grade system to evaluate the function and radiographic outcome of the hip. Results Average age, 9. 9 years （ range ,9-11 years） old, all cases were female, average follow up duration, sixteen months （6-67 months） , six cases were performed the combined procedure and the proximal femoral os-teotomy （PFO） ,only one case was performed the combined procedure in the acetabular side without PFO. No femoral head redislocation or avascular necrosis of the femoral head in the study group up to the latest follow up date. The function the hip according to McKay classification system, one excellent, 2 good, and 4 fair. The ra-diographic outcome of the hip according to Severin grade system, all cases achieved grade Ⅱ . Condusion The combined procedure of acetabularplasty and periacetabular osteotomy could be considered as an option when the severe acetabular pathology in older children need to be solved. In the early follow up, the function of the hip could achieve fair and above and the radiographic outcome was good.

关 键 词：髋脱位 先天性 髋臼 截骨术 

分 类 号：R726.8[医药卫生—儿科]