不同年龄组大龄发育性髋关节脱位患儿手术疗效的临床研究  

Surgical outcomes for delayed diagnosed developmental dysplasia of hip in children

作　　者：沙佳 严亚波[1] 徐会法[1] 李超[1] 黄鲁豫[1] 

机构地区：[1]第四军医大学西京医院骨科,西安710032

出　　处：《中国矫形外科杂志》2017年第9期775-780,共6页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81171735)

摘　　要：[目的]探讨不同年龄组大龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿的手术治疗效果。[方法]2006年11月~2014年6月采用髋关节切开复位,骨盆Pemberton、Dega髋臼成形或三联截骨,股骨旋转短缩截骨结合内收肌切断等手术一期治疗大龄儿童DDH 91例(104髋),按年龄情况将患儿分为两组:低龄组(<10岁):61例(70髋),年龄6~9.8岁,平均7.9岁。高龄组(≥10岁):30例(34髋),年龄10~15岁,平均12.5岁。[结果]91例术后均获得随访,随访时间2~8年,根据Severin影像学评价标准,低龄组:Pemberton术后优良率91.43%,Dega术后优良率85.71%,骨盆三联截骨术后优良率85.71%;高龄组:Pemberton术后优良率58.33%,Dega术后优良率50.00%,骨盆三联截骨术后优良率40.00%。根据Mckay临床评价标准,低龄组:Pemberton术后优良率88.57%,Dega术后优良率85.71%,骨盆三联截骨术后优良率85.71%;高龄组:Pemberton术后优良率58.33%,Dega术后优良率41.67%,骨盆三联截骨术后优良率40.00%。[结论]本研究针对6岁以上大龄DDH患儿的手术疗效进行随访,发现大龄DDH是可以选择性的通过手术治疗的,同时通过比较两组患儿手术疗效的差异,发现低龄组的术后临床及影像学优良率均高于高龄组,提示DDH患儿需要早期手术改善头臼覆盖关系,才有可能获得较好的临床效果。[Objective] To investigate and compare the surgical outcomes of delayed diagnosed developmental dysplesia of the hip （DDH） in different age groups of children. [Methods] From November 2006 to June 2014, 53 patients （61 hips） with delayed diagnosed DDH were treated with Pemberton, Dega, and triple innominate esteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 9 males and 44 females with an average age of 8.8 years ranged from 6 to 15 years. Of them, 37 children （45 hips） were divided into the 〈10 years group and 16 children （16 hips） were enrolled into the ≥10 years group. The patients in the 〈10 years group received Pemberton osteotomy （n=29, 35 hips）, Dega osteotomy （n=6, 8 hips）, and triple innominate osteotomy （n=2, 2 hips）, respectively. While patients in the 310 years group underwent Pemberton osteotomy （n=3, 3 hips）, Dega osteotomy （n=7, 7 hips）, and triple innominate osteotomy （n=6, 6 hips）, respectively. [Results] The patients were followed up for 2 to 8 years with a mean of 7,9 years. According to the Severin radiographic criteria, the excellent and good outcomes in the 〈10 years group were achieved in 91.43% of Pemberton osteotomy （32/35）, 100.00% of Dega esteotomy （8/8）, 100% of triple irmominate osteotomy （2/2）, whereas the rate in the 310 years group was 66.67% of Pemberton osteotomy （2/3）, 71.43% of Dega osteotomy （5/7）, 66.67% of triple innominate osteotomy （4/6） , respectively. In addition, based on Mckay clinical criteria, the 〈10 years group had excellent and good outcomes in 91.43% of Pemberton osteotomy （32/35）, 87.50% ofDega osteotomy （7/8）, 100.00% of triple innominate osteotomy （2/2）, while the 310 years group got that results in 66.7% of Pemberton osteotomy （2/3）, 57.14% of Dega osteotomy （4/7）, and 66.67% of triple innominate osteotomy （3/6）, respectively. [Conclusion] Although delayed diagnosed DDH could still be treated surgically, taking surgical trea

关 键 词：发育性髋关节脱位 大龄儿童 手术疗效 

分 类 号：R726.8[医药卫生—儿科]