髋臼周围截骨术治疗髋关节发育不良的临床效果  

Clinical effect of periacetabular osteotomy in the treatment of hip dysplasia

作　　者：孙明宏 瞿龙 刘英[2] 马爱国[3] 张子春[4] Sun Minghong;Qu Long;Liu Ying;Ma Aiguo;Zhang Zichun(Department of Joint Surgery,the Second Hospital of Tangshan,Tangshan 063000,China;Department of Spine,the Second Hospital of Tangshan,Tangshan 063000,China;Department of Trauma,the Second Hospital of Tangshan,Tangshan 063000,China;Department of Radiology,Tangshan Fengnan District Hospital,Tangshan 063300,China)

机构地区：[1]唐山市第二医院关节外科,唐山063000 [2]唐山市第二医院脊柱科,唐山063000 [3]唐山市第二医院创伤科,唐山063000 [4]唐山市丰南区医院核磁室,唐山063300

出　　处：《中国综合临床》2023年第2期81-84,共4页Clinical Medicine of China

基　　金：河北省卫健委科研课题(20181208)。

摘　　要：目的探讨髋臼周围截骨术(bernese periacetabular osteotomy,PAO)治疗髋关节发育不良(developmental dysplasia of hip,DDH)的临床效果。方法回顾性分析唐山市第二医院2012年1月至2018年6月收治305例DDH患者的临床资料,入院均接受单纯PAO治疗。其中左髋关节发育不良123例,右髋关节发育不良131例,双髋关节发育不良51例,共356髋。患者术前和术后第2天均行X线检查,比较手术前后双髋站立正位髋臼指数和髋臼外侧CE角(lateral center edge angle,LCEA),假斜位(65°斜位)髋臼前CE角(anterior center edge angle,ACEA)。术前和术后6个月均进行日常生活能力和髋关节功能评估,比较治疗前、后Barthel指数及髋关节Harris评分。呈正态分布的计量资料以x¯±s表示,手术前后比较采用配对t检验;非正态分布的计量资料以M(Q1,Q3)表示,手术前后比较采用秩和检验。结果术后第2天,305例患者的356患髋关节LCEA和ACEA均大于术前[32.5°(20.0°,47.5°)比8.5°(-18.5°,23.0°),29.0°(18.5°,52.3°)比2.5°(-20.8°,24.5°)],而髋臼指数小于术前[6.7°(-8.4°,12.5°)比26.8°(10.0°,62.3°)],手术前后比较差异均有统计学意义(Z值分别为51.50、45.37、32.22,均P<0.001)。术后6个月随访,患者Barthel评分和髋关节Harris评分均高于术前[(92.5±1.3)分比(65.6±1.5)分,(96.4±2.5)分比(85.1±1.3)分],差异均有统计学意义(t值分别为335.56、89.70,均P<0.001)。结论PAO可通过髋臼转位使髋臼对股骨头良好覆盖,改善DDH患者的日常生活能力和髋关节功能,减轻疼痛,增加关节活动度,矫正肢体畸形,是治疗DDH的有效手段。Object To explore the clinical effect of periacetabular osteotomy(PAO)in the treatment of developmental dysplasia of hip(DDH).Methods The clinical data of 305 patients with DDH admitted to Tangshan Second Hospital from January 2012 to June 2018 were analyzed retrospectively.All patients were treated with PAO alone.There were 123 cases of left hip dysplasia,131 cases of right hip dysplasia and 51 cases of double hip dysplasia(356 hips in total).The patients underwent X-ray examination before and on the second day after operation to compare the acetabular index and the lateral center edge angle(LCEA)and the anterior center edge angle(ACEA)of the acetabulum before and after operation.The ability of daily living and hip joint function were evaluated before and 6 months after operation,and Barthel index and Harris score of hip joint were compared before and after treatment.The measurement data with normal distribution are expressed in x¯±s,and the paired t test was used for comparison before and after operation.The measurement data of non-normal distribution is expressed by M(Q1,Q3),and the comparison before and after surgery is performed by the rank sum test.Results On the second day after operation,the LCEA and ACEA of 356 hip joints in 305 patients were greater than those before operation(32.5(20.0,47.5)°vs 8.5(-18.523.0)°,29.0(18.5,52.3)°vs 2.5(-20.8,24.5)°),while the acetabulum index was lower than that before operation(6.7(-8.4,12.5)°vs 26.8(10.0,62.3)°),and the differences were statistically significant(Z values were 51.50,45.37,32.22,all P<0.001).After 6 months of follow-up,the Barthel score and Harris score of the hip joint were higher than those before the operation(92.5±1.3)scores vs(65.6±1.5)scores,(96.4±2.5)scores vs(85.1±1.3)scores,and the difference was statistically significant(t values were 335.56 and 89.70,both P<0.001).Conclusions PAO can make the acetabulum cover the femoral head well through acetabular transposition,improve the ability of daily living and hip joint function of DDH pati

关 键 词：髋关节发育不良 髋臼周围截骨术 BARTHEL指数 髋关节Harris评分 

分 类 号：R687.4[医药卫生—骨科学]