Bernese骨盆三联截骨术治疗发育性髋关节发育不良中期疗效的影响因素分析  

Bernese pelvic triple osteotomy in the treatment of developmental dysplasia of the hip

作　　者：李天友[1] 郭锋[1] 李龙[1] 田凯旋[1] 贾伟伟 王延宙[1] Li Tianyou;Guo Feng;Li Long;Tian Kaixuan;Jia Weiwei;Wang Yanzhou(Department of Pediatric Orthopedics,Affiliated Shandong Provincial Hospital,Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院小儿骨科,山东省济南市250021

出　　处：《临床小儿外科杂志》2018年第10期34-38,49,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(编号:81501844);山东省自然科学基金(编号:BS2015YY009);中国博士后科学基金(编号:2017M612285)

摘　　要：目的探讨Bernese骨盆三联截骨术治疗发育性髋关节发育不良(developmental dysplasia of the hip,DDH)中期疗效的影响因素。方法 2010年11月至2011年11月山东大学附属省立医院采用Bernese三联截骨治疗DDH 29例(33髋),平均年龄8岁8个月(3～16岁),其中男童8例,女童21例;左侧18髋,右侧15髋;髋臼发育不良14髋,半脱位14髋,全脱位5髋。29例患儿中11例(13髋)曾行保守治疗(石膏和/或支架),7例(7髋)曾行切开复位联合骨盆截骨和(或)股骨截骨术。所有患儿术后定期随访,按照Mckay临床功能评分和改良Severin影像学评分进行疗效评估,分析临床功能分类和影像学分级与手术年龄、病理类型、既往治疗等影响因素的关系。结果 26例(30髋)获得中期随访,平均随访时间为6年6个月(4年5个月至7年6个月)。按照McKay临床功能评分,优12髋(40. 0%)、良14髋(46. 7%)、中1髋(3. 3%)、差3髋(10. 0%)。按照改良Severin影像学评分,Ⅰ级9髋(30. 0%)、Ⅱ级18髋(60. 0%)、Ⅲ级0髋、Ⅳ级1髋(3. 3%)、Ⅴ级2髋(6. 7%)。临床功能优秀率在不同手术年龄、病理类型、既往有无治疗方面存在差异,但差异无统计学意义(P> 0. 05);年龄≤8岁、髋臼发育不良和既往治疗者影像学优秀率更高,且差异有统计学意义(P <0. 05)。结论 Bernese骨盆三联截骨术治疗DDH中期临床效果良好,年龄≤8岁和髋臼发育不良者影像学结果更佳,值得临床推广应用。Objective To explore the midterm outcomes of Bernese pelvic triple osteotomy for developmental dysplasia of the hip(DDH).Methods A total of 29 patients(33 hips)underwent Bernese pelvic triple osteotomy from November 2010 to November 2011.There were 8 boys and 21 girls with a mean age of 8.67(3-16)years.The involved side was left(n=18)and right(n=15).Before operation,11 cases(13 hips)were treated conservatively(cast and/or brace)while the remainder(7 hips)underwent open reduction with pelvic and/or femoral osteotomy.All ases were followed regularly after operation.Clinical and radiographic outcomes were evaluated with the Mckay criteria and modified Severin criteria respectively.And the correlation factors of clinical and radiographic outcomes,including age,pathological type and previous treatment were analyzed.Results Twenty-six patients(30 hips)were followed up for an average time of 78(53-90)months.According to the Mckay criteria,the outcomes for hips were excellent(n=12,40.0%),good(n=14,46.7%),fair(n=1,3.3%)and poor(n=3,10.0%).Based upon the modified Severin classification,the grades for hips wereⅠ(n=9,30.0%),Ⅱ(n=18,60.0%),Ⅳ(n=1,3.3%)andⅤ(n=2,6.7%)hips.Excellent clinical function was not correlated with age,pathological type or previous treatment.However,excellent radiographic grading was correlated with these factors while the percentage of excellence was higher in cases aged under 8 years,acetabula dysplasia and those with previous treatment.Conclusion The midterm outcome of Bernese pelvic osteotomy for DDH is excellent,especially for those aged under 8 years and acetabula dysplasia.Osteotomy is worth a wider clinical popularization.

关 键 词：髋关节/生长和发育 骨盆 截骨术 股骨头坏死 随访研究 

分 类 号：R726.8[医药卫生—儿科]