Salter截骨联合股骨转子下旋转截骨治疗西藏低龄儿童发育性髋关节发育不良  

Salter Pelvic Osteotomy Combined with Subtrochanteric Rotational Osteotomy in the Treatment of Developmental Hip Dysplasia in Tibetan Children

作　　者：周金雷 李平[1] 杨体敏 Zhou Jinlei;Li Ping;Yang Timin(Department of Orthopaedics,People’s Hospital of Tibet Autonomous Region,Lhasa 850000,China;Tibet University,Lhasa 850000,China)

机构地区：[1]西藏自治区人民医院骨科,西藏拉萨850000 [2]西藏大学,西藏拉萨850000

出　　处：《实用骨科杂志》2025年第2期110-114,共5页Journal of Practical Orthopaedics

基　　金：西藏自治区自然科学基金项目[XZ2024ZR-ZY014(Z)]。

摘　　要：目的探讨Salter骨盆截骨联合股骨转子下旋转截骨治疗西藏低龄儿童Ⅲ、Ⅳ型发育性髋关节发育不良(development dysplasia of the hip,DDH)的临床疗效。方法回顾性收集2012年1月至2019年1月西藏自治区人民医院收治144例(144髋)DDH患儿,其中男31例,女113例;年龄18~68个月,平均(36.40±14.61)个月;按T9nnis分型,Ⅲ型64例,Ⅳ型80例;均行Salter骨盆截骨联合股骨转子下短缩、去旋转个性化截骨。研究手术前后髋臼指数(acetabular index,AI)、中心边缘角(center edge angle,CEA)变化以及术后髋关节功能Mckay等级、术后Severin影像学分型优良率、术后股骨头缺血性坏死(agasculal necrosis of the femoral head,ANFH)发生率。结果患儿术后随访13~53个月,平均(28.00±8.57)个月。末次随访时AI从术前(37.20±4.08)°恢复到(19.96±2.00)°,CEA从术前(-38.46±8.81)°恢复到(29.57±5.70)°;Mckay等级优良率88.19%,Severin影像学分型优良率91.66%,术后再脱位3例;术后ANFH 14例(9.72%),其中Ⅰ型12例(8.33%),Ⅱ型2例(1.38%)。结论Salter骨盆截骨联合股骨转子下旋转截骨治疗西藏低龄儿童Ⅲ、Ⅳ型DDH疗效肯定。Objective To investigate the clinical efficacy of Salter pelvic osteotomy combined with subtrochanteric rotational osteotomy in the treatment of developmental dysplasia of the hip(DDH)in Tibetan children.Methods A retrospective analysis was performed for 144 children with DDH(144 hips)admitted to Tibet Autonomous Region People’s Hospital from January 2012 to January 2019,including 31 males and 113 females.The age was 18~68 months,with an average of(36.40±14.61)months.According to T nnis classification,64 cases wereⅢand 80 cases wereⅣ.Salter pelvic osteotomy combined with subtrochanteric shortening,derotation personalized osteotomy was performed to study the changes of acetabular index(AI)and center edge angle(CEA)before and after surgery,the McKay grade of postoperative hip function score,the excellent rate of Severin imaging classification,and the postoperative avascular necrosis of the femoral head(ANFH).Results The follow-up time of all children was 13~53 months,with an average of(28.00±8.57)months.AI recovered from preoperative(37.20±4.08)°to(19.96±2.00)°,and CEA recovered from preoperative(-38.46±8.81)°to(29.57±5.70)°.The excellent rate of McKay grade was 88.19%,the excellent rate of Severin imaging type was 91.66%,and there were 3 cases of postoperative redislocation.There were 14 cases(9.72%)of postoperative ANFH,including 12 cases(8.33%)with typeⅠand 2 cases(1.38%)with typeⅡ.Conclusion The efficacy of Salter pelvic osteotomy combined with subtrochanteric rotational osteotomy in the treatment of typeⅢandⅣDDH in Tibetan children is certain.

关 键 词：发育性髋关节发育不良 儿童 SALTER截骨 股骨转子下截骨 

分 类 号：R687.31[医药卫生—骨科学]