Dega截骨术治疗学龄前儿童发育性髋关节脱位的疗效分析  被引量:7

Outcomes of Dega osteotomy for developmental dislocation of hip in pre-school children

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作  者:刘帅[1] 张敏刚[1] 李天友[1] 徐跃 葛军涛 王继孟[1] Liu Shuai;Zhang Mingang;Li Tianyou;Xu Yue;Ge J untao;Wang Jimeng(Department of Pediatric Orthopedics, Shandong Provincial Hospital, Affiliated to Shandong University, Jinan 250021 ,China)

机构地区:[1]山东大学附属省立医院小儿骨科,济南250021

出  处:《中华小儿外科杂志》2018年第3期183-189,共7页Chinese Journal of Pediatric Surgery

基  金:国家自然科学基金(81501844);山东省自然科学基金(BS2015YY009)

摘  要:目的分析Dega截骨术治疗学龄前(1.5~6岁)儿童发育性髋关节脱位(developmental dislocation of the hip,DDH)的疗效,总结髋臼成形术的个性化应用体会。方法回顾性分析2007年7月至2012年7月行Dega截骨术治疗的28例(34髋)学龄前DDH患儿的临床资料。本组术时平均年龄(28±10)个月(18~65个月)。34髋均为完全脱位,根据术前X线片上假臼形态分为4组。A组3例3髋,曾行保守治疗,无明显假臼形成;B组7例7髋,未行保守治疗,无明显假臼形成;C组6例9髋,假臼形成明显,压迫侵蚀真臼;D组12例15髋,真假臼广泛融合(融合臼)。分析手术前、后髋关节形态变化、功能改善和股骨头缺血性坏死(avascular necrosis,AVN)的发生情况。 结果术后平均随访(67±14)个月(48~96个月),末次随访时患儿平均年龄(95±15)个月(73~126个月)。平均髋臼指数由45°±6°(32°~57°)改善至10°±7°(-6°~27°);平均Reimer指数由0.95±0.12(0.53~1.00)改善至0.15±0.11(-0.20~0.42);平均中心边缘角术前均视为0,术后为23°±7°(11°~43°),手术前、后比较,差异均有统计学意义(t=26.375、26.253和-18.781,P均〈0.01)。术前34髋Shenton线均不连续,随访时31髋恢复连续性,2髋仍中断,1髋反向不连续。根据改良Severin影像学分类,Ⅰ类20髋、Ⅱ类12髋、Ⅲ类2髋,优良率为94%(32髋/34髋)。根据Kalamchi & MacEwen股骨头缺血性坏死分型,Ⅱ型9髋,余25髋无坏死,坏死率为26%(9髋/34髋)。根据改良McKay临床功能分级,优29髋、良4髋、可1髋,优良率为97%(33髋/34髋)。A、C组行高水平Dega截骨术的5髋均未发生AVN,行低水平Dega截骨术的7髋中5髋(71%)发生AVN,比较两种手术方式的AVN发生率,差异有统计学意义(P=0.028)。B、D组行高水平Dega截骨术的3髋均发生AVN,行低水平Dega截骨�ObjectiveTo explore the outcome of Dega osteotomy for developmental dislocation of the hip (DDH) in pre-school children aged 1.5-6 years and summarize the personalized application experience of acetabular arthroplasty.MethodsA total of 34 involved hips of 28 pre-school DDH children with an average operative age of (28±10)(18-65)months from July 2007 to July 2012 were analyzed retrospectively.All 34 hips were dislocated and classified into 4 groups according to the shapes of false acetabula on preoperative radiography.Three hips of 3 children without false acetabula with conservative treatment previously were distributed into group A; 7 hips of 7 children with no false acetabula and without conservative treatment previously were distributed into group B; 9 hips of 6 children with obvious false acetabula pressing and eroding the true acetabula were distributed into group C; 15 hips of 12 children with extensive fusion of true and false acetabula(fused acetabula)were distributed into group D. Changes of morphologies and improvements of functions of involved hips and the incidence of avascular necrosis (AVN) were evaluated pre- and post-operation.ResultsTwenty-eight children with 34 involved hips were followed up successfully with an average period of(67±14)(48-96) months at an average age of(95±15)(73-126)months.Average acetabular index improved from 45°±6°(32°~57°) to 10°±7°(-6°~27°), average Reimer’s index improved from 0.95±0.12(0.53~1.00)to 0.15±0.11(-0.20~0.42)and average center edge angle was 23°±7°(11°~43°)postoperatively.All differences of changes were statistically significant pre- and postoperatively(t=26.375, 26.253 and -18.781, P〈0.01). All Shenton lines of 34 hips were disrupted preoperatively and 31 of them became continuous at last with disruptions of 2 hips and reversed disruption of 1 hip.Modified Severin classification was applied for evaluating the radiographic improvement with 20 hips of type Ⅰ as excellent, 12

关 键 词: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]

 

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