切开复位联合股骨骨盆截骨治疗儿童单侧发育性髋关节脱位疗效分析  

Clinical outcomes of open reduction combined with pelvic and femoral osteotomy for unilateral developmental dislocation of the hip in children

作　　者：刘圣孟 刘秋亮[1] 史龙彦 张辉[1] 金亚丽[1] 田震 骈凯 LIU Sheng-meng;LIU Qiu-liang;SHI Long-yan;ZHANG Hui;JIN Ya-li;TIAN Zhen;PIAN Kai(Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,He'nan 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2021年第6期599-602,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省卫健委省部共建项目(SB201901019)。

摘　　要：目的探讨髋关节切开复位、骨盆截骨、股骨短缩旋转截骨治疗儿童单侧发育性髋关节脱位的效果。方法单侧发育性髋关节脱位行髋关节切开复位、骨盆Salter截骨、股骨短缩旋转截骨手术患儿53例,根据McKay分级评价末次随访时患儿髋关节临床功能,比较患侧术前与术后髋臼指数、中心边缘角,记录末次随访时股骨头坏死率。比较不同性别、脱位侧别、髋关节脱位组织分级、手术年龄的末次髋臼指数。测量术后不同时间点及末次随访时双侧股骨长度,分析双侧股骨不等长情况。结果平均随访24.8个月。末次随访时,患儿McKay髋关节临床功能优良率为94.34%,股骨头坏死发生率为7.55%;患儿患侧髋臼指数[(20.07±7.35)°]小于术前[(38.75±5.77)°](P<0.05),中心边缘角[(24.52±8.76)°]大于术前[(—48.86±24.55)°](P<0.05);20例随访时间>2年的患儿,术后3 d[(25.49±5.03)°]、2个月[(24.05±6.05)°]、12个月[(20.28±6.82)°]及末次随访时[(18.82±7.75)°]患侧髋臼指数呈逐渐下降趋势(P<0.05)。末次随访时,髋关节脱位组织分级Ⅰ~Ⅲ级[(17.33±5.74)°]、手术年龄<3.5岁[(18.85±6.22)°]患儿髋臼指数小于Ⅳ级、手术年龄≥3.5岁患儿[(21.73±7.78)°、(23.51±9.16)°](P<0.05)。末次随访时,患儿患侧股骨长度[(237.73±53.49)mm]与健侧[(240.26±51.57)mm]比较差异无统计学意义(P>0.05);39例随访时间>12个月的患儿,术后3、12个月患侧股骨长度差值[(36.48±10.24)mm]大于健侧[(29.23±9.72)mm](P<0.05)。结论髋关节切开复位、骨盆截骨、股骨短缩旋转截骨治疗儿童单侧发育性髋关节脱位疗效确切,但需预防术后双下肢不等长及股骨头坏死的发生。Objective To investigate the effect of open reduction,pelvic osteotomy and femoral shortening and derotation osteotomy on unilateral developmental dislocation of the hip in children.Methods Fifty-three children with unilateral developmental dislocation of the hip underwent open reduction,pelvic osteotomy and femoral shortening and derotation osteotomy.McKay criteria was used for assessing the clinical function of the hip at the final follow-up.The acetabular index(AI)and the center-edge angle of preoperation and postoperation were measured and compared.And the incidence rate of osteonecrosis was recorded at the final follow-up.The final AI was compared between different genders,dislocation sides,dislocation stages and ages.The bilateral femur lengths were measured at different postoperative time points and the final follow-up.The unequal length of the bilateral femur was analyzed.Results The patients were followed up for 24.8 months averagely.According to the McKay criteria at the final follow-up,the excellent and good rate was 94.34%.The incidence of avascular necrosis was 7.55%.The AI was smaller at the final follow-up((20.07±7.35)°)than that before operation((38.75±5.77)°)(P<0.05),and the center edge angle((24.52±8.76)°)was larger than that before operation((-48.86±24.55)°)(P<0.05).The AI showed a gradually decreasing trend by day 3 after operation((25.49±5.03)°),in 2 months after operation((24.05±6.05)°),in 12 months after operation((20.28±6.82)°)and at final follow-up((18.82±7.75)°)in 20 children followed up for more than 2 years(P<0.05).At the final follow-up,the AI was smaller in children with stageⅠ-Ⅲ dislocation((17.33±5.74)°)and children aged<3.5 years((18.85±6.22)°)than that in children with stage<Ⅳdislocation((21.73±7.78)°)and children aged≥3.5 years((23.51±9.16)°)(P<0.05).At the final follow-up,there was no significant difference in the length of the femur on the affected side((237.73±53.49)mm)compared with that no the non-affected side((240.26±51.57)mm)(P>0.05).Thir

关 键 词：发育性髋关节脱位 切开复位 骨盆截骨 股骨短缩旋转截骨 股骨头坏死 

分 类 号：R726.8[医药卫生—儿科]