分期Salter骨盆截骨术治疗儿童双侧发育性髋关节脱位的疗效分析  

Outcomes of bilateral developmental dysplasia of the hip after a two-stage procedure of open reduction and Salter osteotomy

作　　者：李海冰 叶文松[1] 徐璐杰[1] 李立[1] 朱伟玮 郑泽峰 徐建仙[1] Li Haibing;Ye Wensong;Xu Lujie;Li Li;Zhu Weiwei;Zheng Zefeng;Xu y ianxian(Department of Pediatric Orthopedics ,Affiliated CI2ildren ＇ s Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China)

机构地区：[1]浙江大学医学院附属儿童医院小儿骨科,杭州310052

出　　处：《中华小儿外科杂志》2018年第3期190-195,共6页Chinese Journal of Pediatric Surgery

基　　金：浙江省医药卫生科技面上项目（2018260443）

摘　　要：目的探讨分期切开复位、Salter骨盆截骨术治疗儿童双侧发育性髋关节脱位（developmental dysplasia of the hip, DDH）的疗效。方法回顾性分析我院2012年1月至2015年1月诊断为双侧DDH患儿19例（38髋）的临床资料。手法方法均采用分期切开复位、Salter骨盆截骨及股骨短缩或旋转截骨术，测量术前、术后第1天及末次随访时患儿髋臼指数。依据年龄将其分为〈3.5岁组（14例28髋）和〉3.5岁组（5例10髋），术后采用McKay髋关节功能评级和Severin髋关节影像学评级评价治疗效果，比较不同年龄组治疗效果的差异，分析股骨头坏死及双髋术后＂不一致＂发生率。结果所有患儿均获随访，随访时间2～5年，平均2.8年。手术间隔时间3～9个月，平均6.2个月。术前平均髋臼指数为37.4°±4.8°，术后第1天为21.3°±3.5°，末次随访时为16.4°±2.9°。末次随访时，Mckay髋关节功能评定优良率为71.1%（27髋/38髋），Severin影像学评定优良率为92.1%（35髋/38髋）。〈3.5岁组髋关节功能评定优良率为85.7%（24髋/28髋），〉3.5岁组为30%（3髋/10髋），组间比较，差异有统计学意义（P＝0.001）。〈3.5岁组Severin影像学评定优良率为92.8%（26髋/28髋），〉3.5岁组为90%（9髋/10髋），组间比较，差异无统计学意义（P＝0.100）。术后共发生股骨头坏死11髋（28.9%），发生术后双髋＂不一致＂9例（47.3%）。结论分期切开复位、Salter骨盆截骨术治疗儿童双侧DDH是一种安全有效的方法，能获得较好的髋关节功能和影像学评级，年龄〈3.5岁患儿较年龄〉3.5岁患儿术后能获得更好的髋关节功能，双髋术后＂不一致＂是其特殊并发症，远期疗效有待进一步观察研究。ObjectiveTo evaluate the outcomes of patients with bilateral developmental dysplasia of the hip undergoing a two-stage procedure of open reduction and Salter osteotomy with associated femoral shortening.MethodsFor this retrospective descriptive study, 19 patients with bilateral developmental dysplasia of the hip （38 hips） were analyzed between January 2012 and January 2015. The procedures consisted of open reduction of the hip, Salter osteotomy, shortening and derotational osteotomy of proximal femur in a two-stage procedure. After cetabular index was measured at pre-operation, one day postoperatively and late postoperatively, they were classified into two group based on operative age： group age 〈3.5 years and group age 〉3.5 years. McKay and Severin criteria were used for assessing the function and radiographic results of the hip. And the incidence rate of osteonecrosis and asymmetrical outcome was analyzed.ResultsAll patients were available at the final follow-up. The average follow-up period was 2.8 （2.0 to 5.0） years. The average of acetabular index at preoperatively was 37.4°±4.8°, the average of acetabular index at one day postoperatively 21.3°±3.5°and the average of acetabular index at late postoperatively 16.4°±3.9°According to the McKay criteria at final follow-up, 27 hips （71.1%） had excellent （13 hips） and good （14 hips） clinical results. According to the Severin criteria, 35 hips （92.1%） had excellent （21 hips） and good （14 hips） radiographic results. If the patients were reclassified by age at time of operation, the rate of excellent and good in group aged 〈3.5 years was 85.7%, it was significantly better than that in group aged 〉3.5 years with 30%; according to the McKay criteria （P=0.001）, the of excellent and good in group aged 〈3.5 years and group aged 〉3.5 years was 92.8% and 90% respectively. No significant differences existed between them according to the Severin criteria （P=0.100）. And the incidence of osteonecrosis and asymmetrica

关 键 词：髋关节脱位 骨盆 截骨术 

分 类 号：R726.8[医药卫生—儿科]