髋关节发育不良伴股骨前倾角异常增大成人患者联合截骨术的疗效  

Clinical effect of periacetabular osteotomy combined with proximal femoral derotational osteotomy in the treatment of developmental dysplasia of the hip with enlarged femoral anteversion angle

作　　者：谷旺 程楠楠 张振东[1,2] 李小娅 罗殿中 张洪[1,2] 程徽 Gu Wang;Cheng Nannan;Zhang Zhendong;Li Xiaoya;Luo Dianzhong;Zhang Hong;Cheng Hui(Senior Department of Orthopedics,the Fourth Medical Center of PLA General Hospital,Beijing,100853;National Clinical Research Center for Orthopedics and Sports Medicine&Rehabilitation,Beijing,100853,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100853 [2]国家骨科与运动康复临床研究中心,北京100853

出　　处：《生物骨科材料与临床研究》2023年第4期4-8,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的对比年龄≥30岁伴股骨前倾角异常增大(>40°)髋关节发育不良患者(developmental dysplasia of the hip,DDH)接受髋臼周围截骨术(periacetabular osteotomy,PAO)联合股骨近端去旋转截骨术(derotational osteotomy,PFDO)与单纯PAO的手术效果。方法选取2012年1月至2020年1月在解放军总医院第四医学中心骨科医学部接受PAO联合PFDO的年龄≥30岁伴股骨前倾角异常增大(>40°)的DDH患者,共计55例,按照接受手术方式不同,分为联合手术组(n=29)和PAO组(n=26)。联合手术组接受PAO联合PFDO治疗,PAO组仅接受PAO治疗。比较两组患者的LCEA、ACEA、Tönnis角术前及术后1年的差异,比较两组患者术前、术后6个月、术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分。结果共计随访55例患者,随访时间为2年1个月~9年11个月。术后6个月,联合手术组与PAO组的改良Harris评分和iHot-12评分相近(P>0.05)。术后1年及末次随访(>2年)的改良Harris评分和iHot-12评分,联合手术组优于PAO组(P<0.05)。结论对于年龄≥30岁伴股骨前倾角异常增大(>40°)的髋关节发育不良患者而言,PAO联合PFDO手术效果优于单纯PAO手术。Objective To compare the effect of periacetabular osteotomy(PAO)combined with proximal femoral derotational osteotomy(PFDO)and PAO in patients with developmental dysplasia of the hip(DDH)over 30 years with excessive femoral anteversion angle(>40°).Methods A total of 55 patients with DDH treated in the Fourth Medical Center of PLA General Hospital from January 2012 to January 2020 were selected,and the patients were divided into combined operation group and periacetabular osteotomy group according to different surgical procedures,with 29 cases in the combined operation group and 26 cases in the periacetabular osteotomy group.The combined operation group was received PAO combined with PFDO,and the periacetabular osteotomy group was received PAO alone.The preoperative and 1 year after operation LCEA,ACEA and Tönnis angle of the two groups were compared.The modified Harris score and iHot-12 score preoperative,and at 6 months,1 year and last follow-up(>2 years)after operation were analyzed and compared.Results A total of 55 patients were followed up,they were followed up from 2 years 1 month to 9 years 11 months.The modified Harris scores and iHot-12 scores of the combined operation group and periacetabular osteotomy group were similar(P>0.05)at 6 months after surgery.The modified Harris scores and iHot-12 scores of the combined operation group were higher than those of the periacetabular osteotomy group(P<0.05)at 1 year and last follow-up(>2 years)after operation.Conclusion The effect of PAO combined with PFDO is superior to PAO alone in DDH patients with excessive femoral anteversion angle(>40°)over 30 years.

关 键 词：发育性髋关节发育不良 股骨前倾角 髋臼周围截骨术 股骨近端去旋转截骨术 

分 类 号：R687.4[医药卫生—骨科学]