Tübingen支具治疗早期发育性髋关节脱位的临床效果及其影响因素分析  

Evaluation and influencing factors of Tübingen Brace treatment for early developmental dysplasia of the hip

作　　者：林然[1] 陈顺有[1] 潘源城[1] 林清坚[1] LIN Ran;CHEN Shunyou;PAN Yuancheng;LIN Qingjian(Department of Orthopedics, Fuzhou Municipal Second Hos pital, Fuzhou, Fujian 350001, China)

机构地区：[1]福建省福州市第二医院小儿骨科,福州350007

出　　处：《福建医药杂志》2018年第2期7-11,共5页Fujian Medical Journal

基　　金：福州市科技计划社会发展项目(2016-S-123-5)

摘　　要：目的探讨Tübingen支具治疗早期GrafⅡb型以上发育性髋关节脱位的临床疗效,并分析临床疗效的影响因素。方法对65例(74髋)发育性髋关节脱位患儿的临床资料进行回顾性分析,所有病例均采用Tübingen支具治疗。至少随访至患儿2岁,末次随访时拍摄骨盆正位X线片,并测量股骨近端干骺端中心边缘角(O point edge,OE)值及髋臼指数(acetabulum index,AI)值。对于治疗后的并发症,根据Tonnis标准判断残余髋臼发育不良,根据Salter标准判断股骨头坏死发生率。结果 74.3%的患儿经Tübingen支具复位成功。随访24~35个月,平均25.6个月,末次随访时,AI值平均(24.0±3.6)°,OE值平均(10.4±5.7)°,8髋(10.8%)存在残余髋臼发育不良,无股骨头坏死发生。本组55髋成功复位患儿中,男性复位成功率为76.9%(10/13),女性为69.2%(36/52),两者比较差异无统计学意义(P>0.05);初始治疗年龄成功复位患儿中,>7周复位成功率为72%(36/54),<7周为90.9%(10/11),两者比较差异无统计学意义(P>0.05);患儿中单侧复位成功率为94.4%(51/54),双侧45.5%(5/11),两者比较差异有统计学意义(P<0.001);超声分型中Ⅱb型复位成功率为100%(38/38),Ⅱc型为90%(9/10),Ⅲ型为35.7%(5/14),Ⅳ型为10%(1/10),各型之间比较差异有统计学意义(P<0.001)。结论 Tübingen支具早期治疗发育性髋关节脱位有效安全。在婴幼儿初始治疗年龄与性别间的复位成功率差异无统计学意义,但是单侧与双侧、不同超声分型间的复位成功率差异有统计学意义。Tübingen支具适用于GrafⅢ型以下发育性髋关节脱位,对GrafⅢ型及Ⅳ型复位失败率高,对GrafⅣ型不建议作为首选治疗方法。Objective To investigate the effects of the Tübingen Brace treatment for the developmental dysplasia of the hip in Infants,and analyze the influencing factors of clinical efficacy.Methods The 65 patients（74 hips）with the DDH were analyzed retrospectively.The patients were all treatmented with the Tübingen Brace and more than two years follow-up.Wiberg OE angle（point O was the middle point of proximal metaphyseal border）and Acetabular index（AI）on the pelvic Xray film at2-3 years of age after successful early treatment were recorded.The residual acetabular dysplasia was diagnosed according to the Tonnis criteria and the femoral head avascular necrosis（AVN）was diagnosed according to the Salter criteria.Results The Tübingen Brace treatment was successful in 55 of the 74 dislocated hips（74.3%）in this series.All patients were followed up for 24-35 months,with an average of 25.6 months.At the last follow-up,the average of AI was（24.0±3.6）°,the average of OE was（10.4±5.7）°,and the eight（10.8%）hips were residual acetabular dysplasia,and no avascular necrosis occurred.The success rate of the Tübingen treatment of male patients was 76.9%（10/13）,female patients was 69.2%（36/52）,and there was no significant difference in the gender（P〉0.05）.The success rate of the Tübingen treatment of more than seven years old patients was 72%（36/54）,less than seven years old patients was 90.9%（10/11）,and there was no significant difference in initial treatment age（P〉0.05）.The success rate of the Tübingen treatment of unilateral dislocation patients was 94.4%（51/54）,bilateral dislocation patients was 45.5%（5/11）,and there was significant difference between the unilateral and bilateral dislocation（P〈0.001）.The success rate of the Tübingen treatment in GrafⅡb was 100%（38/38）,GrafⅡc was 90%（9/10）,GrafⅢ was 35.7%（5/14）,and GrafⅣwas 10%（1/10）,and there was significant difference between different types in Graf（P〈0.001）.Conclusion The

关 键 词：髋关节脱位 发育性 Tübingen支具 超声检查 

分 类 号：R726.8[医药卫生—儿科]