改良Smith-Peterson入路髋臼周围截骨术治疗成人髋关节发育不良  

Periacetabular Osteotomy Through Modified Smith-Peterson forDevelopment Dysplasia of the Hip in Adults

作　　者：林行会 许志庆 庄至坤 吴昭克 Ling Hanghui;Xu Zhiqing;Zhuang Zhikun;Wu Zhaoke(Department of Joint Surgery,Quanzhou Orthopaedics Hospital of Fujian,Quanzhou 36200,China)

机构地区：[1]福建省泉州市正骨医院关节科,福建泉州362000

出　　处：《实用骨科杂志》2023年第12期1070-1074,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨改良Smith-Peterson入路行髋臼周围截骨术(periacetabular osteotomy,PAO)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)的近中期疗效。方法回顾分析泉州市正骨医院2018年4月至2021年1月采用改良Smith-Peterson入路行PAO治疗的21例成人DDH,其中男1例(1髋),女20例(20髋);左髋12例,右髋9例;年龄18~44岁,平均(32.15±10.81)岁;改良T9nnis骨关节炎分期0期5例(5髋),Ⅰ期14例(14髋),Ⅱ期2例(2髋)。记录所有患者术中出血量、手术时间、住院时间、并发症发生情况以及术前术后髋关节Harris评分,通过X线片记录所有患者外侧中心边缘(lateral center edge,LCE)角、臼顶倾斜角(T9nnis角)、股骨头超出指数(extrusion index,EI)及前方中心边缘(anterior center edge,ACE)。结果患者术中出血量(779.52±29.60)mL,手术时间(115.95±4.44)min,住院时间(7.29±0.35)d。术后均获得随访,随访时间24~48个月,平均(33.73±9.12)个月。所有患者均未出现血管损伤、髋臼后柱骨折、切口愈合不良、感染、下肢深静脉血栓。2例(2髋)术后出现股外侧皮神经支配区麻木,未予特殊处理,术后3个月后自行恢复。末次随访Harris评分(89.67±3.44)分优于术前(72.67±4.32)分,差异有统计学意义(P<0.05)。术后12个月X线片示所有患者截骨均愈合,均未出现截骨块骨坏死。术后LCE角(31.67±3.86)°优于术前(9.86±3.25)°,T9nnis角(6.57±2.44)°优于术前(15.05±2.48)°,EI(11.33±2.96)%优于术前(29.19±2.89)%,ACE角(30.67±3.71)°优于术前(8.62±3.31)°,差异均有统计学意义(P<0.05)。结论改良Smith-Peterson入路行PAO治疗成人DDH严格把控手术适应证,重视常见手术并发症的防治,可有效改善髋关节骨性覆盖,显著改善髋关节功能,近中期疗效满意。Objective To evaluate early and mid-term effectiveness of periacetabular osteotomy(PAO)through modified Smith-Peterson for development dysplasia of the hip(DDH)in adults.Methods 21 adults with DDH underwent PAO through modified Smith-Peterson at Quanzhou Orthopaedics Hospital between April 2018 and January 2021.There were 1 male(1 hip)and 20 females(20 hips)containing 12 left hips and 9 right hips.The ages ranged from 18 to 44 years with a mean of(32.15±10.81)years.Among them,5 cases(5 hips)were categorized as modified T nnis stage 0,14 cases(14 hips)as stage I,and 2 cases(2 hips)as stageⅡ.Intraoperative blood loss,surgical duration,hospitalization duration,occurrence of complications and pre-and post-operative Harris hip scores were recorded.Imaging assessments included lateral center edge(LCE)angle,acetabular inclination angle(T nnis angle),extrusion index(EI),and anterior center edge(ACE)measured via X-rays.Results Bleeding volume was(779.52±29.60)mL,operation time was(115.95±4.44)min,the length of hospital stay was(7.29±0.35)days.Follow-up of all patients was(33.73±9.12)months(range 24~48 months).There were no complications such as vascular injury,fracture of posterior column of acetabulum,poor wound healing,infection,deep venous thrombosis of lower extremity.Postoperative numbness of the lateral femoral cutaneous nerve occurred in 2 adults(2 hips)and disappeard postoperatively 3 months without special treatment.At last follow up,Harris hip score was(89.67±3.44),significantly better than preoperative ones(72.67±4.32)(P<0.05).At 1 year after operation,X-ray films showed that the all osteotomies healed and there was no osteotomy block osteonecrosis.Postoperative LCE angle was (31.67±3.86)°,significantly better than preoperative ones (9.86±3.25)°( P <0.05).Postoperative T nnis angle was (6.57±2.44)°,significantly better than preoperative ones(15.05±2.48)°( P <0.05).Postoperative EI was (11.33±2.96)%,which was significantly better than preoperative ones (29.19±2.89)% ( P <0.05).Postoperative AC

关 键 词：改良Smith-Peterson入路 髋臼周围截骨术 髋关节发育不良 

分 类 号：R681.1[医药卫生—骨科学]