折线形骨盆截骨治疗发育性髋关节发育不良  

A new technique of angulated innominate osteotomy for treating developmental dysplasia of the hip

作　　者：刘博 陈述 杨明 吴伟平 金大地 李旭 Liu Bo;Chen Shu;Yang Ming;Wu Weiping;Jin Dadi;Li Xu(Department of Pediatric Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China;Huaxin Orthopaedic Hospital,Guangzhou 510000,China;Department of Orthopaedics,Shenzhen Children's Hospital,Shenzhen 518000,China)

机构地区：[1]南方医科大学第三附属医院骨科,广州510630 [2]广州华新骨科医院,510000 [3]深圳市儿童医院骨科,51800

出　　处：《中华骨科杂志》2019年第17期1061-1067,共7页Chinese Journal of Orthopaedics

摘　　要：目的比较折线形骨盆截骨术和Salter骨盆截骨术治疗发育性髋关节发育不良的疗效。方法回顾性分析2015年1月至2016年12月治疗45例单侧发育性髋关节发育不良患儿,其中14例(男1例,女13例;年龄20~43个月,平均34.21个月)采用Salter骨盆截骨术治疗(传统组),31例(男5例,女26例;年龄17~42个月,平均25.42个月)采用折线形骨盆截骨术治疗(改良组)。比较两组患儿的术中失血量及手术时间。以髋臼指数的变化作为评价手术矫正效果的影像学指标,采用McKay方法评估末次随访时临床功能情况。末次随访时,根据影像学资料判断是否出现股骨头缺血性坏死、脱位或半脱位等并发症。结果患儿均获得随访,其中传统组随访时间8~50个月,平均23.64个月;改良组随访时间8~35个月,平均18.94个月。手术时间,改良组[(262.42±67.56) min]和传统组[(306.43±48.37) min]比较,差异有统计学意义(t=2.482,P=0.018);术中失血量,改良组平均为(81.28±29.00) ml,少于传统组[(117.85±45.55) ml],两组比较差异有统计学意义(t=2.762,P=0.013)。两组患儿经手术后,髋臼指数均获得一定程度的矫正,其中传统组矫正13.19°±2.89°,改良组矫正15.46°±4.29°,两组比较差异有统计学意义(t=-2.078,P=0.045)。末次随访时,McKay评估,其中传统组优6例、良6例、可1例、差1例,优良率为86%(12/14),改良组优24例、良4例、可2例、差1例,优良率为90%(28/31);改良组股骨头缺血性坏死发生率为25.81%(8/31)低于传统组的50%(7/14),传统组2例出现半脱位。结论折线形骨盆截骨术治疗发育性髋关节发育不良的近期疗效优良,较Salter截骨术出血量更少、并发症发生率更低。Objective To introduce a new technique of angulated innominate osteotomy modified from Salter innominate osteotomy and to compare its early clinical effects with the traditional Salter technique. Methods Data of 45 cases treated with innominate osteotomy from January 2015 to December 2016 were retrospectively analyzed. There were 14 cases ( 1 male and 13 females;average age 34.21 months, range from 20 to 43 months) treated by traditional Salter innominate osteotomy (the traditional group) and 31 cases (5 males and 26 females;average age 25.42 months, range from 17-42 months) treated by angulated innominate osteotomy (the modified group). The acetabular index was evaluated radiographically for assessing surgical effects. The operation time and total blood loss during the operation were also collected. McKay method was used for clinical evaluation at the last follow-up. The images of the follow-ups, including the latest one, were used to confirm the exist of complications of avascular necrosis of femoral epiphysis, re-dislocation or subluxation of the hip. Results The mean follow-up time of traditional group was 23.64 months (range, 8-50 months) and modified group's was 18.94 months (range, 8-35 months). The mean time consumption of modified group (262.42±67.56 min) was significantly lower than traditional group's (306.43±48.37 min)(t=2.482, P=0.018) and the mean total amount of blood loss in the modified group was 81.28±29.00 ml, significantly lower than that of the traditional group's of 117.85±45.55 ml (t=2.762, P=0.013). All the involved hips in the two groups achieved varying degrees of deformities correction after surgery. In the traditional group, the mean correction angle was 13.19°±2.89°, compared to 15.46°±4.29° of the modified group's, and there was statistical differences (t=-2.078, P=0.045). As for McKay Results, the excellent combined with good rates in the traditional group and the modified group were 86% and 90%, respectively. The occurrence rate of avascular necrosis of modified group was

关 键 词：儿童 骨盆 截骨术 醜脱位 先天性 

分 类 号：R726.8[医药卫生—儿科]