中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
5期
473-479
,共7页
付喆%杨建平%曾裴%张中礼
付喆%楊建平%曾裴%張中禮
부철%양건평%증배%장중례
髋脱位,先天性%预后%随访研究
髖脫位,先天性%預後%隨訪研究
관탈위,선천성%예후%수방연구
Hip dislocation,congenital%Prognosis%Follow-up studies
目的 探讨发育性髋脱位(developmental dislocation of the hip,DDH)早期手术干预的时机与指证.方法 纳入2000年1月之前出生,经保守治疗后1年内出现残余半脱位畸形,至生长发育停止(髋臼“Y”形软骨闭合)系列骨盆正位X线片完整的DDH患儿共36例48髋.测量髋臼指数(acetabular index,AI)、Reimers指数和CE角,并观察髋臼眉弓形态.采用Severin标准,对末次随访X线片分级,Severin Ⅰ、Ⅱ级为优良,SeverinⅢ、Ⅳ级为中差,分析两组患儿在随访过程中系列X线片各指标的改变.结果 闭合复位时平均年龄1.6岁,末次随访时平均年龄13.8岁,最终18髋(37％,18/48)为Severin Ⅰ、Ⅱ级,30髋(63％,30/48)为SeverinⅢ、Ⅳ级.两组患儿3～4岁时Reimers指数(34.4％±4.5％和43.0％±4.6％)的差异有统计学意义,4～5岁时Reimers指数(29.3％±7.2％和40.0％±6.2％)及CE角(21.0°±5.5°和10.6°±5.2°)的差异均有统计学意义.3～4岁时Reimers指数＞38％(18/18,100％)、4～5岁时Reimers指数＞33％(26/30,87％)的患儿最终为SeverinⅢ、Ⅳ级；4～5岁时Reimers指数＞33％且眉弓向上倾斜(26/26,100％)的患儿最终为SeverinⅢ、Ⅳ级.结论 患儿3～4岁时Reimers指数＞38％、4～5岁时Reimers指数＞33％、眉弓向上倾斜,明显提示远期Seveing分级为Ⅲ、Ⅳ级,应考虑手术矫正,以避免和预防成年后早发性骨关节炎的发生.
目的 探討髮育性髖脫位(developmental dislocation of the hip,DDH)早期手術榦預的時機與指證.方法 納入2000年1月之前齣生,經保守治療後1年內齣現殘餘半脫位畸形,至生長髮育停止(髖臼“Y”形軟骨閉閤)繫列骨盆正位X線片完整的DDH患兒共36例48髖.測量髖臼指數(acetabular index,AI)、Reimers指數和CE角,併觀察髖臼眉弓形態.採用Severin標準,對末次隨訪X線片分級,Severin Ⅰ、Ⅱ級為優良,SeverinⅢ、Ⅳ級為中差,分析兩組患兒在隨訪過程中繫列X線片各指標的改變.結果 閉閤複位時平均年齡1.6歲,末次隨訪時平均年齡13.8歲,最終18髖(37％,18/48)為Severin Ⅰ、Ⅱ級,30髖(63％,30/48)為SeverinⅢ、Ⅳ級.兩組患兒3～4歲時Reimers指數(34.4％±4.5％和43.0％±4.6％)的差異有統計學意義,4～5歲時Reimers指數(29.3％±7.2％和40.0％±6.2％)及CE角(21.0°±5.5°和10.6°±5.2°)的差異均有統計學意義.3～4歲時Reimers指數＞38％(18/18,100％)、4～5歲時Reimers指數＞33％(26/30,87％)的患兒最終為SeverinⅢ、Ⅳ級；4～5歲時Reimers指數＞33％且眉弓嚮上傾斜(26/26,100％)的患兒最終為SeverinⅢ、Ⅳ級.結論 患兒3～4歲時Reimers指數＞38％、4～5歲時Reimers指數＞33％、眉弓嚮上傾斜,明顯提示遠期Seveing分級為Ⅲ、Ⅳ級,應攷慮手術矯正,以避免和預防成年後早髮性骨關節炎的髮生.
목적 탐토발육성관탈위(developmental dislocation of the hip,DDH)조기수술간예적시궤여지증.방법 납입2000년1월지전출생,경보수치료후1년내출현잔여반탈위기형,지생장발육정지(관구“Y”형연골폐합)계렬골분정위X선편완정적DDH환인공36례48관.측량관구지수(acetabular index,AI)、Reimers지수화CE각,병관찰관구미궁형태.채용Severin표준,대말차수방X선편분급,Severin Ⅰ、Ⅱ급위우량,SeverinⅢ、Ⅳ급위중차,분석량조환인재수방과정중계렬X선편각지표적개변.결과 폐합복위시평균년령1.6세,말차수방시평균년령13.8세,최종18관(37％,18/48)위Severin Ⅰ、Ⅱ급,30관(63％,30/48)위SeverinⅢ、Ⅳ급.량조환인3～4세시Reimers지수(34.4％±4.5％화43.0％±4.6％)적차이유통계학의의,4～5세시Reimers지수(29.3％±7.2％화40.0％±6.2％)급CE각(21.0°±5.5°화10.6°±5.2°)적차이균유통계학의의.3～4세시Reimers지수＞38％(18/18,100％)、4～5세시Reimers지수＞33％(26/30,87％)적환인최종위SeverinⅢ、Ⅳ급；4～5세시Reimers지수＞33％차미궁향상경사(26/26,100％)적환인최종위SeverinⅢ、Ⅳ급.결론 환인3～4세시Reimers지수＞38％、4～5세시Reimers지수＞33％、미궁향상경사,명현제시원기Seveing분급위Ⅲ、Ⅳ급,응고필수술교정,이피면화예방성년후조발성골관절염적발생.
Objective To analyze the natural development of the residual subluxation after early close reduction for developmental dislocation of the hip,and to seek the early surgical timing and indication.Methods The research included 36 patients (48 hips) born before January 2000 who showed residual subluxation after close reduction in one year.All of patients had serial X-ray radiographs at every follow-up point.The radiographs were assessed using acetabular index (AI),Reimers index,center edge (CE) angle and the orientation of the sourcil of the acetabulum.The last follow-up results were evaluated according to the Severin classification,and Severin grade Ⅰ and Ⅱ were defined as satisfactory group and Severin grade Ⅲ and Ⅳ as unsatisfactory group.Then we compared and analyzed the serial radiological parameters between satisfactory and unsatisfactory groups.Results The mean age at close reduction was 1.6 years.At the last follow-up,the mean age was 13.8 years.The satisfactory group comprised 18 hips (37％),whereas the unsatisfactory group comprised 30 hips (63％).At the age of three to four years,there was a significant difference between the two groups in the Reimers index (34.4％±4.5％ vs.43.0％±4.6％,P ＜ 0.05).And at four to five years old,there were significant differences for both Reimers index and CE angle (29.3％ ±7.2％ vs.40.0％±6.2％,P ＜ 0.05; 21.0°±5.5° vs.10.6°±5.2°,P ＜ 0.05).When the Reimers index ＞38％ at the age of three to four years,18 of 18 hips fell into the unsatisfactory group.And when Reimers index ＞33％ at the age of four to five years,26 of 30 hips had unsatisfactory result,and in addition to that the sourcil orientation was upward,26 of 26 hips fell into the unsatisfactory group.Conclusion To avoid early osteoarthritis,surgical correction for residual subluxation was recommended if the Reimers index ＞38％ at the age of three to four years or the Reimers index ＞33％ with the sourcil upward at the age of four to five years.
