经改良髂腹股沟入路行髋臼周围截骨术治疗成人髋臼发育不良的中期疗效  

Mid-term effectiveness of periacetabular osteotomy through modified ilioinguinal approach for acetabular dysplasia in adults

作　　者：高仁智 祝兆琛 谢宗平[1] GAO Renzhi;ZHU Zhaochen;XIE Zongping(Department of Orthopedics,the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai,200233,P.R.China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2021年第9期1100-1104,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经改良髂腹股沟入路行髋臼周围截骨术(periacetabular osteotomy,PAO)治疗成人髋臼发育不良的中期疗效。方法回顾分析2016年1月—2018年12月收治且符合选择标准的39例(43髋)髋臼发育不良患者临床资料,均经改良髂腹股沟入路(首先以传统髂腹股沟入路切开皮肤和浅筋膜,深层采用改良髂股入路)行PAO治疗。其中男3例(3髋),女36例(40髋);年龄18~51岁,平均36岁。单髋35例,双髋4例。病程4~96个月,中位数18个月。改良Tönnis骨关节炎分期,0期35髋、Ⅰ期6髋、Ⅱ期2髋。患者均有不同程度髋关节疼痛,术前疼痛视觉模拟评分(VAS)为(4.7±0.8)分,改良Harris髋关节评分为(78.5±8.6)分;外侧中心边缘角(lateral centre-edge angle,LCEA)为(10.52±10.83)°,髋臼指数(acetabular index,AI)为(26.89±9.07)°。记录手术时间、术中出血量以及并发症发生情况,X线片复查LCEA、AI以及骨关节炎进展情况,改良Harris髋关节评分及VAS评分评价髋关节功能及疼痛情况。结果手术均顺利完成;手术时间90~150 min,平均130 min;术中出血量350~600 mL,平均500.6 mL。患者术后均获随访,随访时间17~52个月,平均32.7个月。术后3例出现股外侧皮神经支配区麻木,无其他相关并发症发生。末次随访时,改良Harris髋关节评分为(97.7±3.7)分,VAS评分为(0.9±1.1)分,均较术前改善(P<0.05)。术后1年X线片复查示截骨均愈合。1髋术前改良Tönnis骨关节炎分期为Ⅰ期,末次随访时改善至0期;其余髋关节骨关节炎分期较术前无明显变化。末次随访时,LCEA为(27.54±8.49)°、AI为(11.30±5.53)°,与术前比较差异有统计学意义(P<0.05)。结论经改良髂腹股沟入路行PAO治疗成人髋臼发育不良可明显缓解患者疼痛症状,恢复髋关节功能,中期疗效明确,同时克服传统髂腹股沟入路的不足,可能具有延缓髋关节骨关节炎发展的潜力。Objective To investigate the mid-term effectiveness of periacetabular osteotomy(PAO)through modified ilioinguinal approach for acetabular dysplasia in adults.Methods Between January 2016 and December 2018,39 patients(43 hips)with acetabular dysplasia who met the selection criteria were enrolled in the study and their clinical data were retrospectively analyzed.All patients were treated with PAO via modified ilioinguinal approach(firstly,the skin and superficial facia were cut via the traditional ilioinguinal approach,and the deep tissues were cut via the modified iliacfemoral approach).There were 3 males(3 hips)and 36 females(40 hips)with an average age of 36 years(range,18-51 years).Among them,35 cases of lesions involved single hip and 4 cases of lesions involved bilateral hips.The disease duration ranged from 4 to 96 months,with a median of 18 months.According to the modified Tönnis grading for osteoarthritis,35 hips were classified as grade 0,6 hips as gradeⅠ,and 2 hips as gradeⅡ.All patients had different degrees of hip pain.The preoperative visual analogue scale(VAS)score of pain was 4.7±0.8,and the modified Harris hip score was 78.5±8.6.The lateral centre-edge angle(LCEA)was(10.52±10.83)°,and the acetabular index(AI)was(26.89±9.07)°.The operation time,intraoperative blood loss,and the incidence of complications were recorded.LCEA,AI,and the progression of osteoarthritis were reviewed by X-ray films.The function and pain of hip joint were evaluated by modified Harris hip score and VAS score.Results All operations were successfully completed.The operation time was 90-150 minutes,with an average of 130 minutes.The volume of intraoperative blood loss was 350-600 mL,with an average of 500.6 mL.All patients were followed up 17-52 months,with an average of 32.7 months.Postoperative numbness of the lateral femoral cutaneous nerve occurred in 3 cases,and no other complications occurred.At last followup,the modified Harris hip score was 97.7±3.7 and VAS score was 0.9±1.1,both of which were better than t

关 键 词：髋臼发育不良 髋臼周围截骨术 改良髂腹股沟入路 骨关节炎 成人 

分 类 号：R687.3[医药卫生—骨科学]