CAJ | 학술논문

目的：探讨经髂骨内侧壁髋臼周围旋转截骨术治疗髋臼发育不良的疗效。方法应用经髂骨内侧壁髋臼周围旋转截骨术治疗髋臼发育不良患者36例。取髂腹股沟切口，在髂骨内侧壁骨膜下剥离，显露髋臼底内侧壁，不要解剖髂内血管神经鞘，沿髋臼周围1.5 cm 用骨凿截骨，上缘平坐骨大切迹，下缘在耻骨梳及坐骨体处，凿穿双层皮质，但不要凿穿外侧骨膜，使髋臼成为一游离单位，用顶棒顶压使其向前外及下方旋转，矫正 Sharp 角至35°左右，恢复股骨头正常覆盖率75%以上。自髂前上棘穿入2枚斯氏针顶压在髋臼底内侧壁上。术后无需石膏固定。结果36例中31例术后随访7~82个月，平均22个月。参照 Mckay 评级法，疗效优21例，良8例，差0例。结论经髂骨内侧壁髋臼周围旋转截骨治疗髋臼发育不良，方法简单有效，创伤小，且对骨盆的稳定性影响较小，内固定可靠，不需石膏固定，减轻患者痛苦及避免石膏并发症的发生。可达到缓解患髋疼痛，避免或延缓骨性关节炎的目的。
목적：탐토경가골내측벽관구주위선전절골술치료관구발육불량적료효。방법응용경가골내측벽관구주위선전절골술치료관구발육불량환자36례。취가복고구절구，재가골내측벽골막하박리，현로관구저내측벽，불요해부가내혈관신경초，연관구주위1.5 cm 용골착절골，상연평좌골대절적，하연재치골소급좌골체처，착천쌍층피질，단불요착천외측골막，사관구성위일유리단위，용정봉정압사기향전외급하방선전，교정 Sharp 각지35°좌우，회복고골두정상복개솔75%이상。자가전상극천입2매사씨침정압재관구저내측벽상。술후무수석고고정。결과36례중31례술후수방7~82개월，평균22개월。삼조 Mckay 평급법，료효우21례，량8례，차0례。결론경가골내측벽관구주위선전절골치료관구발육불량，방법간단유효，창상소，차대골분적은정성영향교소，내고정가고，불수석고고정，감경환자통고급피면석고병발증적발생。가체도완해환관동통，피면혹연완골성관절염적목적。
Objective To investigate the effect of periacetabular rotational osteotomy through the medial wall of ilium on acetabular dysplasia. Methods Thirty-six patients with acetabular dysplasia were operated with periacetabular rotational osteotomy through medial wall of ilium. Firstly,the dissec-tion was performed in the subperiosteal plane of the medial ilium via the ilioinguinal incision to expose the medial wall of the bottom of acetabulum. Secondly,without dissecting the internal iliac vasculoneural sheaths,osteotome was used to complete the osteotomy around the acetabulum within 1. 5 cm. The supe-rior portion was greater sciatic notch and the inferior portion was pecten pubis and body of ischium. In or-der to isolate the acetabulum,the two layer cortical bone was cut through and without damaging the later-al periosteum. Thirdly,with the help of biofix rods,the acetabulum was rotated anterolaterally and inferi-orly to correct the Sharp angle to 35° and to restore the coverage rate of femoral head to 75% . Two stein-mann pins were used to put pressure on the medial wall of the bottom of acetabulum through anterior su-perior spine. Postoperatively,none of the operated patients was immobilized. Results Thirty-one of the total 36 patients had 7 to 82 months(average 22 months)of follow up. According to Mckay criteria,the effect was excellent in 21 cases and good in 8 cases. Conclusions Periacetabular rotational osteotomy through the medial wall of ilium for the treatment of acetabular dysplasia is an effective,simple method. It has the advantages of little influence on the stability of pelvis,reliable fixation without external fixa-tion,and can avoide the risk of complications. This method can not only alleviate the patients’pain in the injured hip,but also avoid or delay the development of osteoarthritis.