CAJ | 학술논문

目的探讨髋臼周围截骨治疗成人髋关节发育不良的手术适应证及疗效.方法 25例成人髋关节发育不良患者接受经改良Smith-Peterson人路的髋臼周围截骨术,女19例,男6例;年龄18～45岁,平均25.5岁.均为单侧发病,左侧14例,右侧11例.3例有既往手术史,2例Chari截骨术、1例Salter截骨术.髋关节骨关节炎T(o)nnis 0期13例、Ⅰ期9例、Ⅱ期3例.Shenton线不连续18例.髋臼外侧CE角4.57°±7.39°,前侧CE角0.95°±6.02°,髋臼顶倾斜角32.50°±5.96°,股骨头超出指数38.11%±5.70%,Harris髋关节评分(75.32±7.51)分.结果全部患者随访2.0～7.5年,平均4.5年.3例髋关节骨关节炎T(o)nnis Ⅰ期者改善为0期,2例T(o)nnisⅡ期者改善为Ⅰ期,1例T(o)nnis Ⅰ期者进展为Ⅱ期.Shenton线不连续减少为10例.外侧CE角29.07°±5.81°,前侧CE角29.52°±4.51°,髋臼顶倾斜角19.17°±4.95°,股骨头超出指数24.20%±4.83%,Harris髋关节评分(84.88±4.88)分,与术前比较差异均有统计学意义.16例出现股外侧皮神经支配区感觉麻木,其中9例自行恢复,7例残留永久性麻木.1例出现髋关节周围Brooker Ⅰ型异位骨化.结论经改良Smith-Peterson人路行髋臼周围截骨治疗成人髋关节发育不良可有效增加髋臼包容,改善关节功能,阻止髋臼周围硬化和囊性变,保持关节间隙,延缓骨关节炎进展.
목적 탐토관구주위절골치료성인관관절발육불량적수술괄응증급료효.방법 25례성인관관절발육불량환자접수경개량Smith-Peterson인로적관구주위절골술,녀19례,남6례;년령18～45세,평균25.5세.균위단측발병,좌측14례,우측11례.3례유기왕수술사,2례Chari절골술、1례Salter절골술.관관절골관절염T(o)nnis 0기13례、Ⅰ기9례、Ⅱ기3례.Shenton선불련속18례.관구외측CE각4.57°±7.39°,전측CE각0.95°±6.02°,관구정경사각32.50°±5.96°,고골두초출지수38.11%±5.70%,Harris관관절평분(75.32±7.51)분.결과 전부환자수방2.0～7.5년,평균4.5년.3례관관절골관절염T(o)nnis Ⅰ기자개선위0기,2례T(o)nnisⅡ기자개선위Ⅰ기,1례T(o)nnis Ⅰ기자진전위Ⅱ기.Shenton선불련속감소위10례.외측CE각29.07°±5.81°,전측CE각29.52°±4.51°,관구정경사각19.17°±4.95°,고골두초출지수24.20%±4.83%,Harris관관절평분(84.88±4.88)분,여술전비교차이균유통계학의의.16례출현고외측피신경지배구감각마목,기중9례자행회복,7례잔류영구성마목.1례출현관관절주위Brooker Ⅰ형이위골화.결론 경개량Smith-Peterson인로행관구주위절골치료성인관관절발육불량가유효증가관구포용,개선관절공능,조지관구주위경화화낭성변,보지관절간극,연완골관절염진전.
Objective To study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip (DDH). Methods Twenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years (range, 18-45). Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three cases were operated formerly, 2 of them received Chari osteotomy and 1 received Salter osteotomy. Before operation 13 hips were T(o)nnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.57°±7.39°, the anterior center-edge angle was 0.95°±6.02°, the horizontal tilt angle was 32.50°±5.96°, the femoral head extrusion index was 38.11％±5.70％, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up.Results All patients were followed up for average 4.5 years (range, 2.0-7.5). Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T(o)nnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ, 1 hip of Grade Ⅰ changed into Grade Ⅱ. The incident of the break of Shenton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81° the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20％±4.83％, the Harris hip score increased to 84.88±4.88 points. The major complication included 16 cases of lateral femoral cutaneous nerve palsy (7 cases of them didn't recover forever) and 1 case of ectopic ossification of Brooker Ⅰ . Conclusion Periacetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence,improve hip function; it can also prevent subchondral sclerosis and cysts forming, preserve joint space and delay the occurrence of osteoarthritis.