股骨与骨盆截骨术治疗痉挛性髋关节半脱位的中期疗效  

Middle-term outcomes of femoral varus osteotomy combined with Pemberton osteotomy for spastic hip subluxation

作　　者：肖晟[1] 文捷[1] 刘宏[1] XIAO Sheng;WEN Jie;LIU Hong(Hunan Provincial People＇s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410005, China)

机构地区：[1]湖南省人民医院湖南师范大学附属第一医院,湖南长沙410005

出　　处：《中国矫形外科杂志》2018年第11期993-998,共6页Orthopedic Journal of China

摘　　要：[目的]评估股骨内翻截骨联合骨盆截骨术治疗痉挛性髋关节半脱位的中期临床疗效并讨论其矫正机制。[方法]2011年6月~2015年6月本科采用股骨内翻骨盆截骨术治疗痉挛性髋关节半脱位患儿23例,根据手术前、手术后1年与末次随访时骨盆正位X线片的MP指数和髋臼指数评价临床效果。[结果]所有患儿术后平均随访(39.96±8.50)个月,所有患儿截骨处均得到骨性愈合,术前存在的髋关节半脱位都得到明显改善,患髋活动度正常。MP指数由术前的(57.04±7.18)%显著改进至术后1年复查时的(19.91±5.55)%,末次随访时为(22.43±5.32)%。髋臼指数由术前平均(31.14±3.99)°,显著改进至术后1年复查时的(20.21±2.95)°,末次随访时为(20.63±3.06)°。手术前后MP指数与髋臼指数的差异均有统计学意义(P<0.05)。[结论]股骨内翻骨盆截骨术是治疗MP指数>50°、GMFCS 1~2级的痉挛性髋关节半脱位患儿的一种较好的手术方式。[Objective] To evaluate the middle-term outcomes of femoral varus osteotomy combined with Pemberton osteotomy for spastic hip subluxation, and explore the correction mechanism. [Methods] From June 2011 to June 2014, a total of 23 children underwent femoral varus osteotomy combined with Pemberton osteotomy for spastic hip subluxationin our department. The clinical consequences were evaluated in term of radiographic measurement on pelvic anteroposterior films, including the migration percentage （MP） and acetabular index （AI） before operation, at 1 year, and last follow-up. [Results] The children were followed up for an average of （39.96±8.50） months. All of them got bony union at the osteotomy site, as well as significantly improvement in the hip function with normal range of motion. The average MP significantly improved from （57.04±7.18） % before operation, to （19.91±5.55） % atl year postoperatively and （22.43±5.32） % at the latest follow-up. Similarly, the AI considerably enhanced from （31.14±3.99）° before operation to （20.21＋2.95）° at 1 year postoperatively, further to （20.63±3.06）° at the last follow-up. There were significant differences regarding to MP and AI before and after operation （P〈0.05）. [Conclusions] Femoral varus osteotomy combined with Pemberton osteotomy is a better surgical treatment for children with spastic hip subluxation at levels Ⅰ and Ⅱ of Gross Motor Function Classification System and MP greater than 50%.

关 键 词：痉挛性髋关节半脱位 脑瘫 股骨内翻骨盆截骨术 MP指数 髋臼指数 

分 类 号：R684.7[医药卫生—骨科学]