一期软组织松解、髋关节复位及截骨术治疗脑瘫髋脱位  

One-stage treatment of hip dislocation with cerebral palsy via soft tissue release,hip reduction and osteotomy

作　　者：边臻[1] 郭源[1] 徐刚[1] 杨劼[1] 张建立[1] 吕学敏[1] 杨征[1] 冯超[1] Bian Zhen;Guo Yuan;Xu Gang;Yang Jie;Zhang Jiangli;lyu Xuemin;Yang Zheng;Feng Chao(Department of Pediatric Orthopaedics,Beijing Jishuitan Hospital,the 4th Medical College of Peking University,Beijing 10035,China)

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华骨科杂志》2019年第23期1454-1461,共8页Chinese Journal of Orthopaedics

基　　金：北京市医院管理局“青苗”计划(QML20180401);北京市科学技术委员会资助课题(Z161100000516051)。

摘　　要：目的探讨脑瘫髋脱位的手术策略及其疗效.方法2010年4月至2016年12月采用手术治疗脑瘫髋脱位19例(23髋),男9例,女10例;年龄(12.5±2.4)岁.双下肢瘫17例,偏瘫1例,四肢瘫1例.术前大运动功能分级Ⅰ级2例、Ⅱ级10例、Ⅲ级5例、Ⅳ级2例.手术采用一期软组织松解、髋关节复位、股骨及骨盆截骨术,重建髋关节.随访时评估疼痛症状,摄X线片测量Sharp角及髋臼指数,分析术后再脱位原因.结果全部病例获得随访,平均随访2.1年(范围1~4.5年).全部23髋的外移指数由术前68%±21%降低至术后1年的6%±8%,差异有统计学意义(t=12.760,P<0.001);Sharp角由术前59°±6.1°减小至术后1年的42°±8.9°,差异有统计学意义(t=9.058,P<0.001);"Y"型软骨未闭合15髋,髋臼指数由术前34°±8.7°减小至术后1年的18°±10°,差异有统计学意义(t=5.598,P<0.001).15例获得了稳定的髋关节,行走功能得到改善,其中11例术前主诉髋关节疼痛均得到缓解.4例治疗效果欠佳,其中3例出现髋关节半脱位,术后即刻CE角均小于20°(17°±2.6°),与未复发者(32°±8.0°)的差异有统计学意义(t=3.143,P=0.005);1例行近端腘绳肌松解的患者,术后出现行走功能下降和对侧髋脱位.结论一期软组织松解、髋关节复位、股骨及骨盆截骨术可获得良好的骨性髋臼覆盖,是治疗脑瘫髋脱位的有效方法.截骨方式的选择应依据患者年龄、脱位病理改变等进行综合判断.Objective To investigate the methods and outcomes of surgical treatment for hip dislocation with cerebral palsy(CP)via soft tissue release,hip reduction and osteotomy.Methods Nineteen CP patients(male:9,female:10;total 23 hips)with hip dislocation underwent reconstructive surgery between April 2010 and December 2016.The average age was 12.5±2.4 years.There were 17 diplegic,1 hemiplegic and 1 quadriplegic patient.Gross motor function classification system distribution were type Ⅰ in 2 patients,type Ⅱ in 10 patients,type Ⅲ in 5 patients,type Ⅳ in 2 patients.Combine one-stage surgical procedures included soft tissue release,close or open reduction of hip joint and femoral varus shortening or de-rotational osteotomy and pelvic osteotomy.During the follow-up period,the clinical symptom and radiological parameters including Sharp angle and acetabular index were recorded.Results The average follow-up duration was 2.1 years(1-4.5 years).The radiological parameters were evaluated at one year postoperatively.The migration percentage corrected to 6%±8%from 68%±21%with statistically significant different(i=12.760,P<O.001).The mean Sharp angle was 42°±8.9°,which was statistically significant reduced compared with the preoperative value 59°±6.1°(t=9.058,P<O.001).In 15 patients with triradiate cartilage open,the acetabular index also improved from 34°±8.7°pre-operatively to 18°±10°with statistical significance(t=5.598,P<O.001).Total of 15 patients had gained hip stability and improved functional status.Hip pain,which happened in 11 patients preoperatively,all had relieved after operation.Four patients had dissatisfied results and resubluxation happened in 3 hips.All of them had CE angle<20°immediately after operation(average,17°±2.6°),which was significantly different compared with average CE angle 32°±8.0°in non-recurrence hips(t=3.143,P=0.005).One patient,who underwent proximal hamstring release,had decline of function status and contralateral hip dislocation.Conclusion Dislocation hips in CP pat

关 键 词：脑性瘫痪 髋脱位 截骨术 

分 类 号：R68[医药卫生—骨科学]