髋臼周围截骨术治疗临界发育性髋关节发育不良的疗效  

The effects of periacetabular osteotomy in the treatment of borderline developmental dysplasia of the hip

作　　者：张利强 张洪[3] 罗殿中 程徽 肖凯 任宁涛 胡永成 Zhang Liqiang;Zhang Hong;Luo Dianzhong;Cheng Hui;Xiao Kai;Ren Ningtao;Hu Yongcheng(Postgraduate School,Tianjin Medical University,Tianjin 300070,China;Department of Pediatric Orthopaedics,Shanxi Children's Hospital,Taiyuan 030013,China;Department of Orthopaedics,the Fourth Medical Centre of PLA General Hospital,Beijing 100048,China;Department of Bone and Soft Tissue Oncology,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医科大学研究生院,300070 [2]山西省儿童医院骨科,太原030013 [3]中国人民解放军总医院第四医学中心骨科,北京100048 [4]天津市天津医院骨与软组织肿瘤科,300211

出　　处：《中华骨科杂志》2021年第14期966-976,共11页Chinese Journal of Orthopaedics

摘　　要：目的探讨髋臼周围截骨术(periacetabular osteotomy,PAO)治疗临界发育性髋关节发育不良(developmental dysplasia of the hip,DDH)的疗效。方法回顾性分析2011年1月至2018年1月行PAO治疗的外侧中心边缘角(lateral center-edge angle,LCEA)为18°~25°且随访超过2年的DDH患者33例(18°≤LCEA<25°组);根据患者性别、年龄、体质指数和随访时间按1∶2的比例匹配对照组:0°≤LCEA<10°组66例,10°≤LCEA<18°组66例。比较三组患者术前及末次随访的LCEA、前中心边缘角(anterior center-edge angle,ACEA)、臼顶倾斜角(Tönnis角)、股骨头外移指数、股骨头骨骺臼顶(femoro-epiphyseal acetabular roof,FEAR)指数、股骨前倾角、西安大略和麦克马斯特大学(West Ontario and McMaster University,WOMAC)骨关节炎指数和国际髋关节结果工具(international hip outcome tool,iHOT-12)评分。结果术前18°≤LCEA<25°组33例中3例(9.1%)的LCEA为唯一的影像学特征提示髋臼发育不良而其他参数在正常范围内;ACEA<20°者17例(51.5%)、Tönnis角>10°者24例(72.7%)、ACEA<20°且Tönnis角>10°者12例(36.4%)。18°≤LCEA<25°组后壁征阳性率(72.7%)低于10°≤LCEA<18°组(77.3%)和0°≤LCEA<10°组(90.9%),差异有统计学意义(χ^(2)=6.417,P=0.040);18°≤LCEA<25°组交叉征阳性率(27.3%)和坐骨棘征阳性率(48.5%)高于10°≤LCEA<18°组(分别为10.6%和18.2%)和0°≤LCEA<10°组(分别为9.1%和13.6%),差异有统计学意义(χ^(2)=7.002,P=0.030;χ^(2)=16.497,P<0.001);18°≤LCEA<25°组FEAR指数(3.7±8.0)低于10°≤LCEA<18°组(4.3±7.9)和0°≤LCEA<10°组(11.0±8.8),差异有统计学意义(F=12.703,P<0.001)。术后18°≤LCEA<25°组LCEA由20.4°±1.8°提高至37.8°±7.1°、ACEA由18.3°±7.8°提高至36.3°±6.3°、Tönnis角由12.7°±6.2°降低至-5.6°±9.2°、股骨头外移指数由22.9%±6.7%降低至10.7%±12.2%、WOMAC评分由(20.1±13.4)分降低至(6.0±6.3)分、iHOT-12评分由(50.2±19.9)分提高至(90.0±13.7)分,手术前后的差异Objective To investigate the effects of periacetabular osteotomy(PAO)in treating borderline developmental dysplasia of the hip(DDH).Methods The patients with borderline DDH[lateral center-edge angle(LCEA):18°-25°)who received PAO with follow-up duration for more than 2 years from January 2011 to January 2018 in our hospital were retrospectively analyzed.The patients in the control group were matched on a 1∶2 ratio based on gender,age,body mass index(BMI)and follow-up duration.There were 66 patients in the 0°≤LCEA<10°group and 66 patients in the 10°≤LCEA<18°group.The LCEA,anterior center-edge angle(ACEA),Tönnis angle,femoral head extrusion index,femoro-epiphyseal acetabular roof(FEAR)index,femoral anteversion angle,West Ontario and McMaster University(WOMAC)index and International Hip Outcome Tool(iHOT-12)were compared among the three groups before operation and the last follow-up.Results In the preoperative 18°≤LCEA<25°group,three of 33 patients(9.1%)had LCEA,because the only imaging feature suggested acetabular dysplasia,while other parameters were evaluated within the normal range.There were 17 patients with ACEA<20°(51.5%),24 patients(72.7%)with Tönnis angle>10°,12 patients(36.4%)with ACEA<20°and Tönnis angle>10°.The positive rate of posterior wall signs in the 18°≤LCEA<25°group(72.7%)was lower than that in the 10°≤LCEA<18°group(77.3%)and the 0°≤LCEA<10°group(90.9%)with statistically significant difference(χ^(2)=6.417,P=0.040)at preoperation.The positive rate of cross sign(27.3%)and ischial spine sign(48.5%)in the 18°≤LCEA<25°group were higher than those in the 10°≤LCEA<18°group(10.6%and 18.2%,respectively,χ^(2)=7.002,P=0.030)and the 0°≤LCEA<10°groups(9.1%and 13.6%,respectively,χ^(2)=16.497,P<0.001).The FEAR index in the 18°≤LCEA<25°group(3.7±8.0)lower than that in the 10°≤LCEA<18°group(4.3±7.9)and the 0°≤LCEA<10°group(11.0±8.8)with significant difference(F=12.703,P<0.001).In the 18°≤LCEA<25°group,postoperative LCEA increased from 20.4°±1.8

关 键 词：髋脱位 先天性 截骨术 骨关节炎 髋 

分 类 号：R687.3[医药卫生—骨科学]