San Diego截骨术治疗儿童后外侧髋臼发育不良的临床疗效  

Clinical efficacy of San Diego osteotomy in treating children with dysplasia of the hip after surgery

作　　者：饶宇 杨黎黎 徐永清 齐保闯 唐志方 浦路桥 施洪鑫 任俊筱 李川 Rao Yu;Yang Lili;Xu Yongqing;Qi Baochuang;Tang Zhifang;Pu Luqiao;Shi Hongxin;Ren Junxiao;Li Chuan(Graduate School of Kunming Medical University,Kunming 650500,China;Department of Arthroplasty,920th Hospital of Joint Logistics Support Force of PLA,Kunming 650032,China;Medical School of Dali University,Dali 671003,China;First Clinical Medical College of Yunnan University of Chinese Medicine,Kunming 650500,China)

机构地区：[1]昆明医科大学研究生院,昆明650500 [2]中国人民解放军联勤保障部队第九二○医院关节外科,昆明650032 [3]大理大学临床医学院,大理671003 [4]云南中医药大学第一临床医学院,昆明650500

出　　处：《中华骨科杂志》2024年第13期874-880,共7页Chinese Journal of Orthopaedics

基　　金：云南省科技人才与平台计划(202105AD160027)。

摘　　要：目的:探讨San Diego截骨术治疗儿童后外侧髋臼发育不良的临床疗效。方法:回顾性分析2018年8月至2022年8月在中国人民解放军联勤保障部队第九二○医院采用San Diego截骨术治疗后外侧髋臼发育不良患儿33例。男3例(4髋)、女30例(36髋),年龄(4.9±1.4)岁(范围2~8岁);32例(38髋)为发育性髋关节发育不良、1例(2髋)为麻痹性髋关节脱位。T?nnis分型:Ⅱ型3髋、Ⅲ型25髋、Ⅳ型12髋。通过San Diego截骨术改善髋臼后外侧的覆盖及髋关节外展、内收和屈曲活动度。术后采用改良Severin影像学分级、McKay分级评价疗效。结果:33例患儿均获得随访,随访时间为(37.70±18.44)个月(范围12~74个月),术后均未发生髋关节再脱位、髋臼残余发育不良等并发症。术后6周患儿髋关节外展活动度为24.98°±3.48°、术后3个月为37.28°±4.63°、术后6个月为64.05°±3.82°,差异有统计学意义(F=77.327,P<0.001)。术后6周患儿髋关节内收活动度为1.73°±1.18°、术后3个月为12.33°±1.97°、术后6个月为29.03°±4.17°,差异有统计学意义(F=45.162,P<0.001)。术后6周患儿髋关节屈曲活动度为26.34°±5.05°、术后3个月为76.53°±4.38°、术后6个月为106.47°±2.29°,差异有统计学意义(F=54.377,P<0.001)。髋关节McKay评级,优11髋、良20髋、可9髋,优良率为78%。术后1年Severin影像学分级为Ⅰ级16髋、Ⅱ级24髋。术后3个月5例(5髋)出现股骨头一过性血运障碍,免负重1个月后病变无进展。在随访期间1例患儿右侧髋关节残留股骨头膨大,其余32例(39髋)股骨头均得到良好的骨化塑形。结论:San Diego截骨术治疗儿童后外侧髋臼发育不良术后患儿髋关节活动度增加,髋关节功能满意。Objective To explore the clinical efficacy of the San Diego osteotomy in treating developmental dysplasia of the hip(DDH)in children.Methods A retrospective analysis was conducted on 33 pediatric cases of posterolateral acetabular dysplasia treated with the San Diego osteotomy at the 920th Hospital of the People's Liberation Army Joint Logistics Support Force in China from August 2018 to August 2022.The cohort included 3 males(4 hips)and 30 females(36 hips),with an average age of 4.9±1.4 years(range,2-8 years).Among these,32 cases(38 hips)were diagnosed with DDH,and 1 case(2 hips)with paralytic dislocation of the hip.According to the Tönnis classification,3 hips were classified as type II,25 hips as type III,and 12 hips as type IV.The San Diego osteotomy technique was utilized to enhance the posterior lateral acetabular coverage,combined with femoral osteotomy to adjust the hip abduction,flexion,and adduction angles.Postoperative outcomes were assessed using the modified Severin radiographic classification and the McKay grading system.Results All 33 patients were followed up for an average of 37.70±18.44 months(range,12-74 months).No cases of postoperative hip redislocation or residual acetabular underdevelopment were observed.The hip abduction angle improved from 24.98°±3.48°at 6 weeks postoperatively to 37.28°±4.63°at the 3-month follow-up,and 64.05°±3.82°at the 6-month follow-up,with a statistically significant difference(F=77.327,P<0.001).The hip flexion angle increased from 26.34°±5.05°at 6 weeks postoperatively to 76.53°±4.38°at 3 months,and 106.47°±2.29°at 6 months,also showing a statistically significant difference(F=54.377,P<0.001).The hip adduction angle progressed from 1.73°±1.18°at 6 weeks postoperatively to 12.33°±1.97°at 3 months,and 29.03°±4.17°at 6 months,with a significant difference(F=45.162,P<0.001).The McKay hip joint grading system indicated 11 excellent,20 good,and 9 acceptable outcomes,yielding an overall excellent and good rate of 78%.The Severin radiographic

关 键 词：儿童 髋臼 发育性髋关节发育不良 髋脱位 先天性 截骨术 

分 类 号：R726.8[医药卫生—儿科]