偏心性髋臼旋转截骨术治疗发育性髋关节发育不良  

Eccentric rotary acetabular osteotomy in treatment of developmental dysplasia of hip

作　　者：许银峰[1] 盛璞义[1] 余世明[1] 张阳春[1,2] Xu Yinfeng;Sheng Puyi;Yu Shiming;Zhang Yangchun(Orthopedic,Trauma&Microsurgery,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Orthopedics The Second Affiliated Hospital of Shenzhen University,Shenzhen 518100,China)

机构地区：[1]中山大学附属第一医院骨科-显微外科医学部,广州510080 [2]深圳大学第二附属医院关节外科,518100

出　　处：《中华关节外科杂志(电子版)》2024年第5期568-574,共7页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的分析偏心性髋臼旋转截骨术(ERAO)治疗发育性髋关节发育不良(DDH)患者的临床疗效。方法收集2010年3月至2022年2月在中山大学附属第一医院采用ERAO术治疗的DDH患者,年龄15~60岁,Tönnis髋关节骨关节炎分期<Ⅲ期,排除既往有髋关节手术史、需要行股骨截骨术的患者,纳入研究共78例92个髋关节。其中男28例,女50例,依据Tönnis髋关节骨关节炎分期:0期15髋,Ⅰ期67髋,Ⅱ期10髋。根据髋关节发育不良的Crowe分型,均为Ⅰ型患者。临床评估以Harris评分为标准,影像学评估则通过拍摄术前与术后骨盆前后位、患髋正侧位,观察头臼指数(AHI)、外侧中心边缘角(LCEA)及Sharp角等,观察有无感染、神经血管损伤等并发症。通过t检验比较术前、术后差异有无统计学意义。结果纳入患者平均年龄(45±16)岁,术后随访时间为12~138个月,平均随访时间(68±32)个月。术后及6个月的短期随访中,除2例伤口周围感染,无神经血管损伤等其他并发症;5年以上的随访中,有5例5髋再次行人工全髋关节置换术。Harris评分由ERAO术前(73.5±9.4)分提高至(89.8±6.2)分,差异有统计学意义(t=-7.8,P<0.001);术前Sharp角为(52.2±3.8)°,术后改善为(42.4±3.2)°(t=3.1,P<0.05);LCEA由术前的(10.7±2.6)°升至(35.8±6.5)°;AHI由术前的(48.9±6.5)%升至术后的(88.0±10.7)%,股骨头中心与泪滴的水平距离由术前的(41.2±9.4)mm缩小为术后的(37.3±8.6)mm,与泪滴的垂直距离由术前的(20.8±10.5)mm缩小为术后的(17.2±10.1)mm。结论ERAO明显矫正了DDH患者髋臼畸形形态,改善了髋关节异常的受力模式,延缓了髋关节骨关节炎病变的进展,短期及中期疗效确切,是治疗DDH有效的手术方法,值得推广应用。Objective To analyze the clinical effect of eccentric rotary acetabular osteotomy(ERAO)in the treatment of developmental dysplasia of the hip(DDH).Methods From March 2010 to February 2022,patients with DDH and treated by ERAO in the First Affiliated Hospital of Sun Yat-sen University were collected.The patients who were evaluated as under stage III of Tönnis hip osteoarthritis staging and aged from 15 to 60 years were enrolled,while the patients with hip surgery history or requiring femoral osteotomy were excluded.A total of 78 patients with 92 hip joints were included in this study.There were 28 males and 50 females.According to Tönnis grades of hip osteoarthritis,there were 15 hips in stage zero,67 hips in stageⅠ,and 10 hips in stageⅡ.According to the Crowe classification of hip dysplasia,all the patients were type I.The Harris score was used as the standard for clinical evaluation.Imaging evaluation was conducted by photographing the anterior and posterior positions of the pelvis before and after surgery and the anterior and lateral positions of the affected hip to observe the acetabular head index(AHI),lateral center-edge angle(LCEA)and Sharp angle,as well as to observe whether there were complications such as infection and neurovascular injury.Comparing preoperative and postoperative differences for statistical significance through t test.Results The patients were(45±16)years old on average,and the follow-up time was 12 to 138 months,(68±32)months on average.In the shortterm and six months follow-up after surgery,except for two cases of wound infection,there was no other complication such as neurovascular injury.During more than five years follow-up,five patients with five hips underwent total hip replacements.Harris score elevated from(73.5±9.4)to(89.8±6.2)after ERAO surgery,and the difference was statistically significant(t=-7.8,P<0.001).The sharp angle was(52.2±3.8)°before surgery,and was improved to(42.4±3.2)°after surgery(t=3.1,P<0.05).The LCEA increased from(10.7±2.6)°before surgery to(

关 键 词：髋脱位 先天性 截骨术 骨关节炎 髋 髋臼 成年人 

分 类 号：R687.3[医药卫生—骨科学] R687.4[医药卫生—外科学]