中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
1期
1-7
,共7页
髋脱位,先天性%截骨术%髋臼%中年人
髖脫位,先天性%截骨術%髖臼%中年人
관탈위,선천성%절골술%관구%중년인
Hip dislocation,congenital%Osteotomy%Acetabulum%Middle aged
目的 探讨经髂腹股沟入路髋臼周围截骨治疗中年髋关节发育不良的手术适应证及疗效.方法 回顾性分析2005年8月至2010年2月采用经髂腹股沟入路髋臼周围截骨术治疗10例髋关节发育不良患者资料,男3例,女7例；年龄40～47岁,平均42岁；3例为双侧(单侧手术)、7例为单侧髋关节发育不良；左侧4例,右侧6例.2例有既往手术史,其中1例行Chari截骨术,1例行髋臼造盖术.髋关节骨关节炎分期:T(o)nnis 0期3例,Ⅰ期5例,Ⅱ期2例.6例Shenton线不连续.髋臼外侧CE角3.50°±4.88°,前侧CE角1.80°±5.07°,髋臼顶倾斜角18.20°±3.01°,股骨头超出指数31.30％±4.37％,Harris髋关节评分(67.40±7.75)分.结果 10例患者均获得随访,随访时间10～76个月,平均37个月.1例术前T(o)nnis Ⅰ期者术后改善为0期,1例Ⅱ期者改善为Ⅰ期,其余分期无变化.术后2例Shenton线不连续.末次随访外侧CE角30.40°±3.31°,前侧CE角29.50°±3.03°,髋臼顶倾斜角4.50°±2.55°,股骨头超出指数9.90％±4.33％,Harris髋关节评分(84.10±4.07)分.3例出现股外侧皮神经支配区感觉麻木,4～6个月自行恢复.1例出现髂窝血肿,2周后吸收消失,无残留症状.结论 只要严格掌握手术适应证,术中精细操作,经髂腹股沟入路髋臼周围截骨可治疗中年髋关节发育不良.
目的 探討經髂腹股溝入路髖臼週圍截骨治療中年髖關節髮育不良的手術適應證及療效.方法 迴顧性分析2005年8月至2010年2月採用經髂腹股溝入路髖臼週圍截骨術治療10例髖關節髮育不良患者資料,男3例,女7例；年齡40～47歲,平均42歲；3例為雙側(單側手術)、7例為單側髖關節髮育不良；左側4例,右側6例.2例有既往手術史,其中1例行Chari截骨術,1例行髖臼造蓋術.髖關節骨關節炎分期:T(o)nnis 0期3例,Ⅰ期5例,Ⅱ期2例.6例Shenton線不連續.髖臼外側CE角3.50°±4.88°,前側CE角1.80°±5.07°,髖臼頂傾斜角18.20°±3.01°,股骨頭超齣指數31.30％±4.37％,Harris髖關節評分(67.40±7.75)分.結果 10例患者均穫得隨訪,隨訪時間10～76箇月,平均37箇月.1例術前T(o)nnis Ⅰ期者術後改善為0期,1例Ⅱ期者改善為Ⅰ期,其餘分期無變化.術後2例Shenton線不連續.末次隨訪外側CE角30.40°±3.31°,前側CE角29.50°±3.03°,髖臼頂傾斜角4.50°±2.55°,股骨頭超齣指數9.90％±4.33％,Harris髖關節評分(84.10±4.07)分.3例齣現股外側皮神經支配區感覺痳木,4～6箇月自行恢複.1例齣現髂窩血腫,2週後吸收消失,無殘留癥狀.結論 隻要嚴格掌握手術適應證,術中精細操作,經髂腹股溝入路髖臼週圍截骨可治療中年髖關節髮育不良.
목적 탐토경가복고구입로관구주위절골치료중년관관절발육불량적수술괄응증급료효.방법 회고성분석2005년8월지2010년2월채용경가복고구입로관구주위절골술치료10례관관절발육불량환자자료,남3례,녀7례；년령40～47세,평균42세；3례위쌍측(단측수술)、7례위단측관관절발육불량；좌측4례,우측6례.2례유기왕수술사,기중1례행Chari절골술,1례행관구조개술.관관절골관절염분기:T(o)nnis 0기3례,Ⅰ기5례,Ⅱ기2례.6례Shenton선불련속.관구외측CE각3.50°±4.88°,전측CE각1.80°±5.07°,관구정경사각18.20°±3.01°,고골두초출지수31.30％±4.37％,Harris관관절평분(67.40±7.75)분.결과 10례환자균획득수방,수방시간10～76개월,평균37개월.1례술전T(o)nnis Ⅰ기자술후개선위0기,1례Ⅱ기자개선위Ⅰ기,기여분기무변화.술후2례Shenton선불련속.말차수방외측CE각30.40°±3.31°,전측CE각29.50°±3.03°,관구정경사각4.50°±2.55°,고골두초출지수9.90％±4.33％,Harris관관절평분(84.10±4.07)분.3례출현고외측피신경지배구감각마목,4～6개월자행회복.1례출현가와혈종,2주후흡수소실,무잔류증상.결론 지요엄격장악수술괄응증,술중정세조작,경가복고구입로관구주위절골가치료중년관관절발육불량.
Objective To investigate the indications and mid-term outcomes of periacetabular osteotomy through ilioinguinal approach for developmental dysplasia of the hip (DDH) in middle-aged (40-50years old) adult patients.Methods Data of 10 adult patients who had undergone periacetabular osteotomies through ilioinguinal approach for DDH from August 2005 to February 2010 were retrospectively analyzed.There were 7 females and 3 males,aged from 40 to 47 years (average,42 years).Bilateral hips were involved in 3 patients,and unilateral hip was involved in 7 patients.Before this hospitalization,1 patient had received Chari osteotomy,and 1 had received hip-shelf procedure.According to the T(o)nnis classification,3 hips were classified as Grade 0,5 as Grade Ⅰ and 2 as Grade Ⅱ.The Shenton line was discontinuous in 6 hips.The average lateral center-edge angle was 3.50°±4.88°; the average anterior center-edge angle was 1.80°±5.07°; the average acetabular index angle was 18.20°±3.01°; the average femoral head extrusion index was 31.30％±4.37％; the average Harris hip score was 67.40±7.75.Changes of the indexes mentioned above were observed during the whole period of follow-up.Results All patients were followed up for 10 to 76 months (average,37 months).The T(o)nnis grade improved in 2 cases,from preoperative Grade Ⅰ and Grade Ⅱ to Grade 0 and Grade Ⅰ at final follow-up,respectively.At final follow-up,the Shenton line was discontinuous in 2 hips; the average lateral center-edge angle improved to 30.40°±3.31°,the average anterior center-edge angle improved to 29.50°±3.03°,the average acetabular index angle decreased to 4.50°±2.55°,the average femoral head extrusion index decreased to 9.90％±4.33％; the average Harris hip score increased to 84.10±4.07.The major complications included 3 cases of lateral femoral cutaneous nerve palsy which recovered in 4 to 6 months,and 1 case of iliac fossa hematoma which disappeared in 2 weeks.Conclusion With more strict surgery indication and more meticulous manipulation,periacetabular osteotomy through ilioinguinal approach can achieve satisfactory results in the treatment of DDH in middle-aged adults,which can increase hip joint congruence,relieve hip symptom and delay progression of osteoarthritis.
