一期联合手术治疗2～6岁发育性髋关节脱位儿童的临床和影像学结果评价  

Clinical and radiological outcomes of one-stage surgery for developmental dislocation of the hip in children

作　　者：刘柱[1] 李浩[1] 张志强[1] 陈秋[1] 李海[1] 范清[1] 张自明[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿骨科,200092

出　　处：《中华小儿外科杂志》2017年第7期511-515,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（81372001）

摘　　要：目的 通过回顾性分析2～6岁发育性髋关节脱位儿童一期行切开复位＋ Salter骨盆截骨＋股骨近端截骨术的联合手术方法的临床和影像学的随访结果,探讨2～3岁行一期联合手术是否会增加股骨头缺血性坏死（AVN）的风险.方法 收集2009年1月1日至2010年12月31日期间,在我院一期行切开复位＋ Salter骨盆截骨＋股骨截骨术的联合手术,年龄在2～6岁之间的发育性髋关节脱位患儿共31例（45髋）,进行临床功能和影像学的随访研究.所有患儿按照手术时的年龄分为两组,1组为≤3岁（28髋）,2组为＞3岁（17髋）.根据T（o）nnis分型,Ⅲ型30髋（1组21髋,2组9髋）,Ⅳ型15髋（1组7髋,2组8髋）.股骨头缺血性坏死分级评价采用Kalamchi-MacEwen分型,临床功能结果采用McKay评分标准.结果 患儿手术时平均年龄为（37.22±11.60）个月.术后随访（5.93±0.76）年.最终随访时拍摄的骨盆X线正位片,采用Kalamchi-MacEwen分型判定未发生AVN共31髋（68.2％）,发生AVN共14髋（31.1％）.1组共19（67.9％）髋未发生AVN,共9髋（32.1％）发生AVN.2组分别为12髋（70.6％）和5髋（29.4％）,两者之间差异并无统计学意义（P=0.560）.在1组发生AVN的患儿中,Ⅰ型4髋（44.4％）,Ⅱ型1髋（11.1％）Ⅲ型3髋（33.3％）,Ⅳ型1髋（11.1％）,2组分别为Ⅰ型3髋（60％）,Ⅱ型1髋（20％）,Ⅲ型0,Ⅳ型1髋（20％）.根据McK-ay评分系统,优秀33髋（73.3％）,良好7髋（1 5.6％）,一般4髋（8.9％）,差1髋（2.2％）.两者之间差异并无统计学意义（P=0.944）.所有45髋中,只有1例出现半脱位行二次手术,再手术的发生率为2.22％.结论 发育性髋关节脱位儿童在2～6岁时行一期联合手术长期随访的临床功能和影像学结果是满意的.儿童在2～3岁时行一期联合手术并没有显著增加AVN的发生,并获得良好的髋关节临床功能.这说明2～3岁时行一期联合手术可以获得良好的效果,是Objective To evaluate the clinical and radiological outcomes of one-stage surgery for developmental dislocation of the hip （DDH） in children and explore whether such a procedure increase the risk of avascular necrosis （AVN） in children aged 2 to 3 years.Methods From January 2009 to December 2010,a total of 31 children （45 hips） aged 2 to 6 years received one-stage surgeries including open reduction,Salter innominate osteotomy and proximal femoral osteotomy They were divided into two groups according to treatment age：Group 1 （28 hips） aged ≤3 years and Group 2 （17 hips） aged 3-6 years.T（o）nnis and Kalamchi-MacEwen classifications were used for classifying the radiographic features of hip at pre and post-operation.Thirty hips were defined as grade Ⅲ （21 hips in group 1;9 hips in group 2） and 15 hips grade Ⅳ （7 hips in group 1;8 hips in group 2）.Clinical outcomes were assessed with the modified McKay＇s scoring system.Results The mean operative age was 37.22 ± 11.60 months and the mean follow-up period 5.93 ± 0.76 years.According to the Kalamchi-MacEwen classification,AVN was observed in 14 hips （31.1%） at the final follow-up.In group 1,AVN was present in 9 hips （32.1 %）.The grades were Ⅰ （44.4 %）,Ⅱ （11.1 %）,Ⅲ （33.3%） and Ⅳ （11.1%）.In group 2,AVN was found in 5 hips （29.4 %）.And the grades were defined Ⅰ （60%）,Ⅱ （20%） and Ⅳ （20%）.No significant inter-group difference existed （P =0.560）.Furthermore,according to McKay＇s scoring system,73.3% patients yielded excellent outcomes whereas 15.6% had good results.No significant inter-group difference was noted （P =0.944）.One patient required re-operation for residual subluxation.And the re-operative rate was 2.22%.Conclusions One-stage procedures of open reduction,Salter innominate osteotomy and proximal femoral osteotomy are efficacious for DDH in children aged 2-6 years.Also it is safe for patients aged ≤3 years to obtain satisfactory clinical outcomes without a hig

关 键 词：发育性髋关节脱位 截骨术 股骨头缺血性坏死 

分 类 号：R726.8[医药卫生—儿科]