髋臼坐骨切迹周围截骨与Pemberton截骨治疗儿童发育性髋关节脱位的中期随访对比研究  

Comparative study of periacetabular sciatic notch osteotomy versus Pemberton osteotomy in the treatment of developmental hip dislocation in children

作　　者：雷霆[1] 朱光辉[1] 刘昆[1] 唐进[1] 伍江雁[1] 谭谦[1] 叶卫华[1] 梅海波[1] Lei Ting;Zhu Guanghui;Liu Kun;Tang Jin;Wu Jiangyan;Tan Qian;Ye Weihua;Mei Haibo(Department of Orthopedics,Hunan Children s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院骨科,长沙410007

出　　处：《临床小儿外科杂志》2022年第8期731-737,共7页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科建设项目-湖南省儿童医院小儿外科(湘卫医发[2022]2号);婴幼儿发育性髋关节脱位早期筛查及治疗(202218015914)。

摘　　要：目的比较髋臼坐骨切迹周围截骨(periacetahular sciatic-notch osteotomy,PASO)与Pemberton截骨(pemberton osteotomy,PO)治疗儿童发育性髋关节脱位(development dislocation of the hip,DDH)的临床疗效。方法以湖南省儿童医院骨科自2004年5月至2021年11月收治、且随访时间在5年以上的DDH患儿为研究对象,按照不同的骨盆截骨方式分为PASO组(47例61髋)和PO组(29例35髋)。比较两组患儿手术后矫正髋臼指数(correction acetabulum index,CAI)、末次随访髋臼指数(terminal acetabulum index,TAI)、中心边缘角(central edge angel,CEA)、Severin X线评价优良率与Mckay临床髋关节功能评价优良率。结果本研究平均随访时间:PASO组(7.14±1.59)年,PO组(5.77±0.60)年;术前平均髋臼指数:PASO组(39.66±5.46)°,PO组(41.47±3.48)°;术后CAI:PASO组(26.63±7.35)°,PO组(23.92±5.61)°,差异均无统计学意义(P>0.05)。TAI:PASO组(12.25±8.17)°,PO组(16.67±4.98)°,P<0.01;CEA:PASO组(35.28±8.50)°,PO组(29.05±7.60)°,P<0.01,差异均有统计学意义。末次随访时Mckay髋关节功能评价:PASO组中优43髋,良13髋,可4髋,差1髋,优良率91.8%;PO组中优30髋,良3髋,可2髋,差0髋,优良率94.2%;末次随访时Severin评价:PASO组中优45髋,良14髋,中1髋,差1髋,优良率96.7%;PO组中优24髋,良8髋,中3髋,差0髋,优良率91.4%。股骨头缺血性坏死(avascular necrosis of femoral head,AVN):PASO组发生AVN 1型0髋、2型2髋、3型2髋、4型4髋,AVN发生率13.1%;PO组发生AVN 1型0髋、2型2髋、3型1髋、4型3髋,AVN发生率17.1%。结论与Pemberton截骨手术比较,髋臼坐骨切迹周围截骨同样是一种有效的治疗发育性髋关节脱位的方法。Objective To compare the effects of periacetabular sciatic notch osteotomy(PASO)of pelvis and Pemberton osteotomy(PO)of pelvis in the treatment of developmental dislocation of the hip(DDH)in children.Methods From May 2004 to November 2021,DDH children undergoing PASO(n=47,61 hips)and PO(n=29,35 hips)were followed up.Correction degree of acetabulum index(CAI),terminal acetabulum index(TAI),central edge angle(CEA)and excellent/good rate of Severin radiological evaluation and McKay clinical hip function evaluation were compared.Results The average follow-up time was(7.14±1.59)years in PASO group and(5.77±0.60)years in PO group.The mean preoperative acetabular index was(39.66±5.46)°in PASO group and(41.47±3.48)°in PO group,postoperative CAI:PASO group(26.63±7.35)°,PO group(23.92±5.61)°(P>0.05);TAI:PASO group(12.25±8.17)°,PO group(16.67±4.98)°(P<0.01);CEA:PASO group(35.28±8.50)°versus PO group(29.05±7.60)°(P<0.01).The McKay hip function evaluation in PASO group:excellent 43 hips,good 13 hips,fair 4 hips,poor 1 hip.The excellent/good rate was 91.8%.PO group:excellent 30 hips,good 3 hips,fair 2 hips and poor 0 hips.The excellent/good rate was 94.2%.Severin rated PASO group:excellent 45 hips,good 14 hips,medium 1 hip,poor 1 hip.And the excellent/good rate was 96.7%;PO group:excellent 24 hips,good 8 hips,medium 3 hips,poor 0 hips.The excellent/good rate was 91.4%.In PASO group,there were 0 hips in AVN1 group,2 hips in AVN2 group,2 hips in AVN3 group and 4 hips in AVN4 group.The incidence of AVN was 13.1%.In PO group,there were 0 hips in AVN1 group,2 hips in AVN2 group,1 hip in AVN3 group and 3 hips in AVN4 group.The incidence of avascular necrosis of femoral head(AVN)was 17.1%.Conclusion As compared with pemberton osteotomy,PASO is an effective treatment of DDH.

关 键 词：髋脱位 先天性/外科学 截骨术 治疗结果 随访研究 儿童 

分 类 号：R726.8[医药卫生—儿科]