改良Colonna关节囊成形术治疗青少年单侧脱位型发育性髋关节发育不良的中远期疗效  

Mid-and long-term efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type of juvenile developmental dysplasia of the hip

作　　者：李川 罗殿中 刘傥[3] 程徽 沈超[4] 叶涛 齐保闯 蒙旭晗 唐志方 徐永清 浦路桥 Li Chuan;Luo Dianzhong;Liu Tang;Cheng Hui;Shen Chao;Ye Tao;Qi Baochuang;Meng Xuhan;Tang Zhifang;Xu Yong qing;Pu Luqiao(Department of Orthopaedics,920th Hospital of the Joint Logistics Force of the Chinese People's Liberation Army,Kunming 650032,China;Department of Orthopaedics,Fourth Medical Center,General Hospital of the Chinese People's Liberation Army,Beijing 100048,China;Department of Orthopaedics,Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Orthopaedics,Xinhua Hospital,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032 [2]中国人民解放军总医院第四医学中心骨科,北京100048 [3]中南大学湘雅二医院骨科,长沙410011 [4]上海交通大学附属新华医院骨科,上海200092

出　　处：《中华骨科杂志》2024年第6期388-394,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨改良Colonna关节囊成形术治疗青少年单侧脱位型发育性髋关节发育不良的中远期临床疗效。方法回顾性分析2016年1月至2018年1月于解放军联勤保障部队第九二〇医院接受改良Colonna关节囊成形术治疗的青少年单侧脱位型DDH患者28例,男4例、女24例,年龄(16.5±5.0)岁(范围10~25岁),体质指数(21.2±1.1)kg/m^(2)(范围18.7~24.1 kg/m^(2))。DDH分型:TonnisⅢ型10例、Ⅳ型18例。测量术后外侧中心边缘角、髋臼覆盖率、股骨前倾角及双下肢长度差。记录手术时间、术中出血量、髋关节疼痛视觉模拟评分(visual analogue scale,VAS)、Harris髋关节评分(Harris hip score,HHS)和先天性髋关节脱位疗效评定标准评分。结果所有患者均顺利完成手术并获得随访,随访时间为(72.1±5.2)个月(范围60~84个月)。手术时间为(81.6±4.3)min(范围70~90 min),术中出血量为(177.5±12.6)ml(范围160~200 ml),住院时间为(6.8±0.7)d(范围6~9 d)。患者术前髋关节VAS评分为(1.8±0.6)分,末次随访为(2.3±0.6)分,差异无统计学意义(t=2.845,P=0.224)。患者术前HHS评分为(57.1±5.9)分,末次随访时升高至(87.3±4.0)分,差异有统计学意义(t=-22.141,P=0.001)。末次随访时股骨前倾角为17.0°±1.5°,小于术前的41.6°±2.4°,差异有统计学意义(t=-44.868,P=0.008);双下肢长度差为(10.2±2.3)mm,小于术前的(26.4±6.1)mm,差异有统计学意义(t=-12.892,P<0.001);外侧中心边缘角为28°(26°,30°),髋臼覆盖率为78%(76%,79%);先天性髋关节脱位疗效评定标准评分为24(16.7,25.7)分,其中优7例、良14例、可4例、差3例,优良率为75%(21/28)。结论改良Colonna关节囊成形术治疗青少年单侧脱位型发育性髋关节发育不良术后中远期髋关节功能恢复和影像学指标改善良好。ObjectiveTo investigate the mid-and long-term clinical efficacy of modified Colonna arthroplasty in the treatment of unilateral dislocation type developmental dysplasia of hip(DDH)in adolescents.MethodsA total of 28 adolescent DDH patients with unilateral dislocation who underwent modified Colonna capsular arthroplasty from January 2016 to January 2018 in the 920th Hospital of Joint Logistics Support Force of People's Liberation Army were retrospectively analyzed.There were 4 males and 24 females,aged 16.5±5.0 years(range,10-25 years).The mean body mass index was 21.2±1.1 kg/m^(2)(range,18.7-24.1 kg/m^(2)).According to DDH classification,10 cases were Tonnis type III and 18 cases were Tonnis type IV.The postoperative lateral center-edge angle,acetabular coverage,femoral anteversion angle and leg length discrepancy were measured.The operation time,intraoperative blood loss,visual analogue scale(VAS)of hip pain,Harris hip score(HHS)and congenital dislocation of the hip score were recorded.ResultsAll patients successfully completed the operation and were followed up for 72.1±5.2 months(range,60-84 months).The operation time was 81.6±4.3 min(range,70-90 min),the intraoperative blood loss was 177.5±12.6 ml(range,160-200 ml),and the hospital stay was 6.8±0.7 days(range,6-9 days).The VAS score of the hip joint was 1.8±0.6 before operation and 2.3±0.6 at the last follow-up,and the difference was not statistically significant(t=2.845,P=0.224).The preoperative HHS score was 57.1±5.9,and it increased to 87.3±4.0 at the last follow-up,and the difference was statistically significant(t=-22.141,P=0.001).At the last follow-up,the femoral anteversion angle was 17.0°±1.5°,which was lower than that before operation 41.6°±2.4°,with a statistically significant difference(t=-44.868,P=0.008).The leg length discrepancy was 10.2±2.3 mm,which was lower than that before operation(26.4±6.1 mm),with a statistically significant difference(t=-12.892,P<0.001).The lateral center-edge angle was 28°(26°,30°),and the acetabula

关 键 词：发育性髋关节发育不良 关节囊 外科手术 随访研究 

分 类 号：R726.8[医药卫生—儿科]