髋臼周围截骨术结合髋关节镜手术治疗成人发育性髋关节发育不良  

Effects of periacetabular osteotomy combined with hip arthroscopy in treating developmental dysplasia of the hip

作　　者：陈哲峰 王瑞 刘久翔 刘锋 Chen Zhefeng;Wang Rui;Liu Jiuxiang;Liu Feng(Department of Orthopaedics,the First Affiliated with Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]南京医科大学第一附属医院骨科,210009

出　　处：《中华骨科杂志》2021年第14期920-928,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨髋臼周围截骨术(periacetabular osteotomy,PAO)结合髋关节镜手术治疗成人发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的疗效。方法2015年12月至2018年6月采用PAO结合关节囊切开术治疗DDH患者40例(关节囊切开组),男3例、女37例,年龄(31.08±11.24)岁;2018年7月至2019年6月采用PAO结合髋关节镜手术治疗DDH患者21例(髋关节镜组),男2例、女19例,年龄(33.25±11.70)岁。术后6个月和12个月随访,评估改良Harris髋关节功能评分(modified Harris hip score,mHHS)、非骨关节炎髋关节评分(nonarthritic hip score,NAHS)、髋关节结果评分日常生活能力量表(hip outcome score activity of daily living scale,HOS-ADL)。结果两组术前外侧中心边缘(lateral center edge,LCE)角分别为8.53°±9.09°和9.15°±10.86°,前方中心边缘(anterior center edge,ACE)角分别为13.69°±12.43°和7.18°±15.74°,Tönnis角分别为20.12°±6.24°和22.13°±8.86°,外凸指数分别为38.97%±7.55%和37.64%±10.01%,组间差异均无统计学意义(P>0.05);髋关节镜组中α角>50°者17例、关节囊切开组31例,两组合并Cam畸形(α角>50°)的发生率分别为81%(17/21)和78%(31/40),差异无统计学意义(χ^(2)=0.096,P=0.756)。术后1年两组DDH影像学指标均较术前改善,LCE角分别为34.29°±5.07°和32.76°±9.48°、ACE角分别为32.87°±4.23°和30.26°±5.39°、Tönnis角分别为-1.82°±5.88°和2.16°±7.89°、外凸指数分别为16.81%±4.53%和18.20%±9.16%,组间差异均无统计学意义(P>0.05)。两组α角分别为39.27°±6.73°和39.20°±5.13°,组间差异无统计学意义(t=0.039,P=0.969)。术后6个月两组mHHS评分、NAHS评分和HOS-ADL评分均较术前提高,分别为(73.95±10.18)分和(65.90±7.84)分、(79.61±7.65)分和(73.00±11.07)分、(67.55±8.52)分和(76.70±4.87)分,组间差异无统计学意义(P>0.05)。术后1年两组mHHS评分分别为(87.90±4.34)分和(86.50±5.11)分,差异无统计学意义(t=1.135,P=0.261);髋关�Objective To investigate the effects of periacetabular osteotomy(PAO)combined with hip arthroscopy in treating adult developmental dysplasia of the hip(DDH).Methods A total of sixty-one patients with DDH who received PAO surgery were enrolled in the present retrospective study.Of all patients,forty of them were treated by PAO combined with open arthrotomy from December 2015 to June 2018 as arthrotomy group.There were three males and 37 females in this group.Twenty-one DDH patients,including 2 males and 19 females,were treated by PAO combined with hip arthroscopy from July 2018 to June 2019 as arthroscopy group.The average ages were 31.08±11.24 and 33.25±11.70 years,respectively.Radiological parameters before and after surgery were compared between two groups.Modified Harris hip score(mHHS),nonarthritic hip score(NAHS),hip outcome score activity of daily living scale(HOS-ADL)at 6 months and 12 months postoperatively were compared between two groups.Results The preoperative LCE(lateral center edge)angle,ACE(anterior center edge)angle,Tönnis angle,extrusion index in each group were 8.53°±9.09°vs.9.15°±10.86°,13.69°±12.43°vs.7.18°±15.74°,20.12°±6.24°vs.22.13°±8.86°and 38.97%±7.55%vs.37.64%±10.01%respectively.There was no statistical difference between two groups.Cam deformity(αangle>50°)existed in 17 patients(81%,17/21)in arthroscopy group and in 31 patients(78%,31/40)in arthrotomy group without significant difference between two groups(χ^(2)=0.096,P=0.756).At 12 months follow-up,all radiological parameters were improved from those before surgery.The LCE angle,ACE angle,Tönnis angle,extrusion index were 34.29°±5.07°vs.32.76°±9.48°,32.87°±4.23°vs.30.26°±5.39°,-1.82°±5.88°vs.2.16°±7.89°and 16.81%±4.53%vs.18.20%±9.16%between groups without significant difference.The preoperative mHHS,NAHS,HOS-ADL in two groups were 60.38±12.19,50.90±8.54,72.23±11.86 and 60.00±13.53,52.55±7.92,72.70±12.18 respectively.At 12 months,there was no statistical difference in mHHS between the

关 键 词：截骨术 髋脱位 先天性 关节镜检查 

分 类 号：R687.4[医药卫生—骨科学]