CAJ | 학술논문

目的探讨应用髋臼周围截骨术治疗髋关节发育不良的初步临床结果.方法 2002年2月至2008年2月,应用髋臼周围截骨术治疗髋关节发育不良患者53例(55髋),女51例,男2例;年龄13～51岁,平均25.5岁.术前髋部疼痛史1个月～6年,平均16个月.6例曾经接受过髋部手术.术前WibergCE角为-20°～15°,平均3°.根据Tonnis分型,术前轻度关节炎16例,中度1例.外展位头臼关系基本正常,25例有Shenton线分离.前13例取髂腹股沟入路,后40例(42髋)采用改良Smith-Petersen入路.6例同时行转子部内翻截骨.结果全部病例随访12～60个月,平均28个月.术后3个月均获骨性愈合.髋部疼痛症状明显改善或消失.Harris评分由术前平均77.4分提高至末次随访94.6分.术后髋关节活动度较术前减小,总活动度减小20°～60°,以屈曲活动为主.术后Wiberg CE角20°～50°,平均29°.5例出现跛行,主要由臀中肌无力造成,经功能锻炼后好转.18例出现股外侧皮神经损伤,2例出现骨盆环断裂,均与手术初期经验不足有关.无截骨不愈合、血管损伤、截骨进入髋关节等并发症.结论对年龄较轻的髋关节发育不良患者,髋臼周围截骨术可获得较满意的临床结果.该术式可多维矫正髋臼畸形,髋臼截骨块血供不受影响,骨盆环的稳定性得以保存,患髋可以早期活动.
목적 탐토응용관구주위절골술치료관관절발육불량적초보림상결과.방법 2002년2월지2008년2월,응용관구주위절골술치료관관절발육불량환자53례(55관),녀51례,남2례;년령13～51세,평균25.5세.술전관부동통사1개월～6년,평균16개월.6례증경접수과관부수술.술전WibergCE각위-20°～15°,평균3°.근거Tonnis분형,술전경도관절염16례,중도1례.외전위두구관계기본정상,25례유Shenton선분리.전13례취가복고구입로,후40례(42관)채용개량Smith-Petersen입로.6례동시행전자부내번절골.결과 전부병례수방12～60개월,평균28개월.술후3개월균획골성유합.관부동통증상명현개선혹소실.Harris평분유술전평균77.4분제고지말차수방94.6분.술후관관절활동도교술전감소,총활동도감소20°～60°,이굴곡활동위주.술후Wiberg CE각20°～50°,평균29°.5례출현파행,주요유둔중기무력조성,경공능단련후호전.18례출현고외측피신경손상,2례출현골분배단렬,균여수술초기경험불족유관.무절골불유합、혈관손상、절골진입관관절등병발증.결론 대년령교경적관관절발육불량환자,관구주위절골술가획득교만의적림상결과.해술식가다유교정관구기형,관구절골괴혈공불수영향,골분배적은정성득이보존,환관가이조기활동.
Objective To report the preliminary results of treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy. Methods From February 2002 to February 2008, 53 patients (55 hips) with DDH were treated with periacetabular osteotomy. 51 patients were females, 2 were males, with the average age of 25.5 years (ranged, 13 to 51 years). The hip pain period before surgery varied from 1 month to 6 years (mean 16 months). 6 patients had the history of hip surgery. The mean Wiberg CE angle was 3°(range, -20°to 15°). According to Tonnis osteoarthritis classification, there were 16 cases in grade Ⅰ, 1 in grade Ⅱ. 25 patients had Shenton's line broken. The ilioinguinal approach was used in former 13 cases. The modified Smith-Petersen approach was used in later 40 cases. Intertrachanteric varus osteotomy was done simultaneously in 6 cases. Results The mean follow-up period was 28 months (ranged, 12 to 60 months). Bone union was achieved in 3 months after surgery. The pain relieved in most of patients. The Har-ris hip score increased from 77.4 points (ranged, 68 to 87 points) preoperatively to 94.6 points (ranged, 70 to 100 points) post-operatively. The range of motion of the hip decreased 20°-60° after surgery. The mean CE angle increased to 29°(ranged, 20° to 50°) postoperatively. 5 patients had limp after surgery, mostly due to dysfunction of gluteus medius, and recovered after 6 months of exercises. 18 patients got lateral femoral cu-taneous nerve injury. Two patients suffered pelvic ring broken and healed without affecting on hip function.No complication such as infection, vascular injury, sciatic neve injury happened in this series. Conclusion Satisfactory results can be obtained through periacetabular osteotomy in young patients with DDH. Periac-etabular osteotomy can correct the acetabular deformity in multiplanar. No vascular impair in acetabular fragment. The stability of the pelvic can be reserved. Early rehabilitation is allowed after surgery.