Chiari骨盆内移截骨治疗儿童股骨头缺血坏死的远期疗效分析  

Long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children

作　　者：臧俊亭[1] 王宇航[2] 冯卫[1] 刘建国[1] 李冬松[1] 赵星宇[1] 高航[1] 李长胜[1] ZANG Jun-ting;WANG Yu-hang;FENG Wei;LIU Jian-guo;LI Dong-song;ZHAO Xing-yu;GAO Hang;LI Chang-sheng(Department of Orthopaedics,the First Hospital of Jilin University,Changchun 130021,Jilin,China)

机构地区：[1]吉林大学第一医院骨关节外科,吉林长春130021 [2]吉林大学第一医院日间观察病房,吉林长春130021

出　　处：《中国骨伤》2019年第8期696-700,共5页China Journal of Orthopaedics and Traumatology

基　　金：吉林省科技发展计划项目(编号:20150520150JH)~~

摘　　要：目的:探讨Chiari骨盆内移截骨治疗CatterallⅢ、Ⅳ型儿童股骨头缺血坏死的长期随访结果,分析截骨角对临床及放射线结果的影响。方法:自2005年3月至2013年7月,采用Chiari骨盆内移截骨术治疗26例CatterallⅢ、Ⅳ型儿童股骨头缺血坏死患者,其中男17例,女9例,年龄4~13(8.9±2.6)岁。通过截骨角将患者分为低截骨角组和高截骨角组,低截骨角组10例,其中男8例,女2例,年龄4~13(9.2±3.3)岁,截骨角为10°;高截骨角组16例,其中男9例,女7例,年龄6~12(8.8±2.1)岁,截骨角为15°。比较两组患者术前及末次随访时HHS髋关节功能评分、髋关节CE角、髋臼指数、Sharp角、Shenton线是否连续、股骨头包容度百分比及髋臼深宽比,并采用Stulberg分级评估标准评价股骨头塑形情况。结果:26例患者获得随访,时间4.5~12.0(7.9±1.8)年。术后患者切口均Ⅰ期愈合,时间10~14(12.3±1.1)d,术后无感染、皮肤坏死、血管神经损伤等并发症。所有截骨断端获得愈合,时间8~13(9.8±1.4)周。低截骨角组HHS评分由术前的75.8±6.5提高至末次随访时的93.5±2.5(P<0.05);高截骨角组HHS评分由术前的77.6±6.2提高至末次随访时97.8±1.6(P<0.05);高截骨角组优于低截骨角组(P<0.05)。低截骨角组髋臼指数由术前的(10.1±2.5)°降低到末次随访时的(4.5±1.3)°(P<0.05),高截骨角组髋臼指数由术前的(10.7±3.3)°降低至末次随访时的(2.0±1.1)°(P<0.05);高截骨角组髋臼指数优于低截骨角组(P<0.05)。两组治疗前后CE角、Sharp角、Shenton线是否连续、股骨头包容度百分比及髋臼深宽比较差异无统计学意义。根据Stulberg分级评估标准,高截骨角组股骨头塑形能力优于低截骨角组(P<0.05)。结论:Chiari骨盆内移截骨术治疗CatterallⅢ、Ⅳ型儿童股骨头缺血坏死时,采用15°截骨角能够更有效地降低髋臼指数,有助于提高股骨头塑形能力,从而更明显地改善临床结果。Objective:To explore long-term outcomes of Chiari osteotomy for Legg-Calvé-Perthes disease in children with type CatterallⅢorⅣ,and to analyze clinical effect of osteotomy angle on clinical and radiographic results.Methods:From March 2005 to July 2013,26 children with Legg-Calvé-Perthes disease with type CatterallⅢorⅣwere treated by Chiari osteotomy,including 17 males and 9 females,aged from 4 to 13 years old with an average of(8.9±2.6)years old.Children were divided into low osteotomy angle group and high osteotomy angle group.according to osteotomy angle.There were 10 children in low osteotomy angle group with an osteotomy angle of 10 degrees,including 8 boys and 2 girls,aged from 4 to 13 years old with an average of(9.2±3.3)years old;while there were 16 children in high osteotomy angle group with an osteotomy angle of 15 degress,including 9 boys and 7 girls,aged from 6 to 12 years old with an average of(8.8±2.1)years old.HHS score before operation and at the latest follow-up were recorded to observe clinical results.CE angle of hip joint,acetabular index,Sharp angle,Shenton's line continuity,femoral head coverage,acetabular depth ratio were recorded to compare radiographic results.Stulberg classification was analyzed to compare reshaping ability of femoral head.Results:Twenty-six children were followed up for 4.5 to 12.0 years with an average of(7.9±1.8)years.All incisions were healed at stageⅠfor 10 to 14 days,with an average of(12.3±1.1)days.No inflammation,skin necrosis and injury of vessel and nerve occurred.All osteotomies achieved bone union for 8 to 13 weeks,with an average of(9.8±1.4)weeks.HHS score increased from 75.8±6.5 before operation to 93.5±2.5 at the latest follow-up in low osteotomy angle group(P<0.05),and form 77.6±6.2 to 97.8±1.6 in high osteotomy angle group(P<0.05).HHS score of high osteotomy angle group at the latest follow-up was higher than that of low osteotomy angle group(P<0.05).The acetabular index decreased from(10.1±2.5)°before operation to(4.5±1.3)°at the

关 键 词：股骨头坏死 截骨术 骨盆 儿童 

分 类 号：R681[医药卫生—骨科学]