Salter骨盆截骨术后髋关节形态学发育变化的研究  

Morphological change of developmental dislocation of the hip after Salter pelvis osteotomy

作　　者：刘振江[1] 马瑞雪[1] 吉士俊[1] 

机构地区：[1]中国医科大学附属第二医院小儿外科,沈阳110004

出　　处：《中华小儿外科杂志》2004年第1期47-50,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的　观察Salter骨盆截骨术治疗发育性髋脱位后的髋关节形态学发育变化特点。方法　对本组 4 0例 (4 5髋 ) ,男 5例 ,女 35例 ,进行Salter骨盆截骨术 ,观察术后髋臼指数 (acetabularin dex ,AI)、髋臼指数深宽比 [acetabularindexofdepthtowidth ,AI(D/W ) ]、CE角 (center edgeangle)、臼头指数 (acetabular headindex ,AHI)、髋臼宽度增长率、股骨头增大率和闭孔面积比率的变化趋势 ,结合临床功能和X线片表现进行评分 ,平均随访 5 .7年。结果　术后AI和AHI逐年减小 ,3～ 4年AI稳定于 15°左右 ,AHI达到正常 ;AI(D/W )和CE角逐年增加 ,分别于 5年以后 ,3～ 4年达到正常 ;髋臼宽度增长率和股骨头增大在术后 3～ 4年最明显 ;患侧闭孔面积术后当时明显减少 ,6个月恢复。评分优良率 97.5 %。结论　Salter骨盆截骨术时患儿正处于儿童发育的第一高潮 ,塑形能力强 ,术后3～ 4年髋关节已近正常 ,以后髋关节包容继续加深 ,形态日趋完善。此年龄阶段手术可引起头大而影响覆盖 ,并应避免剧烈运动 ,防止过早发生骨关节炎。Objective To characterize the morphological progress of developmental dislocation of the hip after Salter pelvis osteotomy. Methods Forty patients(45hips) were followed-up for an average of 5.7 years. The following indices were studied: the postoperative acetabular index (AI), acetabular-head index (AHI), center-edge angle (CE angle), acetabular index of depth to width [AI(D/W)], acetabular width growth rate, the enlargement rate of femoral head and the ratio of area of obturator foramen. Clinical assessment was correlated with X-ray findings in 40 hips.Results AI and AHI decreased gradually with time. AI was within 15°and AHI was more than 84% 3～4 years postoperativly. AI(D/W) and CE angle increased gradually. They were close to normal at 5 years of age or 3～4 years postoperativly. The acetabular width growth rate and the enlargement of femoral head were most obvious 3～4 years postoperativly. The ratio of the area of obturator foramen decreased significantly at the immediate postoperative stage, and completely recovered 6 months postoperatively. Excellent and good results were obtained in 97.5% of patients. Conclusions The child was in the first developmental peak when Salter innominate osteotomy was performed and the remodeling potential was great. The hip was close to that of normal 3～4 years postoperativly, and the hip joints hold the femoral heads properly and the fit was close to perfect. However, Salter pelvis osteotomy may result in increased femoral head at this age and result in inadequate cover. Excessive physical activity should be avoided to minimise osteoarthrosis.

关 键 词：SALTER骨盆截骨术 髋关节 形态学 发育性髋脱位 骨关节炎 适应证 

分 类 号：R726.8[医药卫生—儿科]