中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
12期
897-901
,共5页
罗殿中%张洪%程徽%肖凯
囉殿中%張洪%程徽%肖凱
라전중%장홍%정휘%초개
髋脱位,先天性%发育障碍%关节成形术%修复外科手术%随访研究
髖脫位,先天性%髮育障礙%關節成形術%脩複外科手術%隨訪研究
관탈위,선천성%발육장애%관절성형술%수복외과수술%수방연구
Hip dislocation,congenital%Developmental disabilities%Arthroplasty%Reconstructive surgical procedures%Follow-up studies
目的 通过对改良Colonna髋关节复位关节囊成形术病例的早期随访,探讨该手术在治疗年轻患者单侧髋关节脱位中的早期效果.方法 2011年7月至2013年2月,共有25例符合手术适应证患者(25髋)在解放军总医院第一附属医院进行改良Colonna关节囊成形手术治疗.其中男性7例,女性18例;年龄9.7 ～25.8岁,平均17.8岁;左侧12例,右侧13例;体重指数15.6～29.6 kg/m2,平均20.9 kg/m2.观察指标包括:术前术后髋关节活动度、Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、视觉模拟量表(VAS)评分,术后患者对手术效果的满意度,以及末次随访时Severin分级、T(o)nnis骨关节炎分级.对术前、术后功能评价指标进行配对t检验.将所有患者按照手术治疗时年龄分为＜16岁组(15例)和≥16岁组(10例),采用成组资料方差分析比较两组患者末次随访时的功能评价指标及患者对手术满意度.结果 患者均获得随访,随访时间12 ～ 18个月,平均13.4个月.髋关节活动度明显减小:术前平均380°,末次随访平均200°.术后9个月与术前比较,Harris髋关节评分(78 ±9比84 ±15,t=2.107,P=0.046)及WOMAC功能评分(14.8±8.4比8.6±9.6,t=-2.657,P=0.014)差异均有统计学意义.在末次随访中所有评分均有明显改善,但差异无统计学意义.末次随访时＜16岁组的VAS疼痛评分和对手术效果的满意程度明显优于≥16岁组,VAS评分分别为1.1±0.8和2.8±1.4(F=12.810,P=0.002),手术满意度分别为89±17和66±22(F=7.535,P=0.012).术后Severin分级为:Ⅰ级21髋、Ⅱ级l髋、Ⅲ级2髋、Ⅳ级2髋;术后T(o)nnis骨关节炎程度,0级5髋、1级12髋、2级7髋、3级1髋.结论 大部分青少年单侧髋脱位的患者经改良Colonna关节囊成形术治疗获得满意的复位和早期治疗效果,术后有较长康复过程,低龄组(＜16岁)治疗效果优于大龄组(≥16岁).通过严格手术适应证,精准手术操作技术与优化术后康复方案有望提高术后疗效.
目的 通過對改良Colonna髖關節複位關節囊成形術病例的早期隨訪,探討該手術在治療年輕患者單側髖關節脫位中的早期效果.方法 2011年7月至2013年2月,共有25例符閤手術適應證患者(25髖)在解放軍總醫院第一附屬醫院進行改良Colonna關節囊成形手術治療.其中男性7例,女性18例;年齡9.7 ～25.8歲,平均17.8歲;左側12例,右側13例;體重指數15.6～29.6 kg/m2,平均20.9 kg/m2.觀察指標包括:術前術後髖關節活動度、Harris髖關節評分、西安大略和麥剋馬斯特大學骨關節炎指數(WOMAC)評分、視覺模擬量錶(VAS)評分,術後患者對手術效果的滿意度,以及末次隨訪時Severin分級、T(o)nnis骨關節炎分級.對術前、術後功能評價指標進行配對t檢驗.將所有患者按照手術治療時年齡分為＜16歲組(15例)和≥16歲組(10例),採用成組資料方差分析比較兩組患者末次隨訪時的功能評價指標及患者對手術滿意度.結果 患者均穫得隨訪,隨訪時間12 ～ 18箇月,平均13.4箇月.髖關節活動度明顯減小:術前平均380°,末次隨訪平均200°.術後9箇月與術前比較,Harris髖關節評分(78 ±9比84 ±15,t=2.107,P=0.046)及WOMAC功能評分(14.8±8.4比8.6±9.6,t=-2.657,P=0.014)差異均有統計學意義.在末次隨訪中所有評分均有明顯改善,但差異無統計學意義.末次隨訪時＜16歲組的VAS疼痛評分和對手術效果的滿意程度明顯優于≥16歲組,VAS評分分彆為1.1±0.8和2.8±1.4(F=12.810,P=0.002),手術滿意度分彆為89±17和66±22(F=7.535,P=0.012).術後Severin分級為:Ⅰ級21髖、Ⅱ級l髖、Ⅲ級2髖、Ⅳ級2髖;術後T(o)nnis骨關節炎程度,0級5髖、1級12髖、2級7髖、3級1髖.結論 大部分青少年單側髖脫位的患者經改良Colonna關節囊成形術治療穫得滿意的複位和早期治療效果,術後有較長康複過程,低齡組(＜16歲)治療效果優于大齡組(≥16歲).通過嚴格手術適應證,精準手術操作技術與優化術後康複方案有望提高術後療效.
목적 통과대개량Colonna관관절복위관절낭성형술병례적조기수방,탐토해수술재치료년경환자단측관관절탈위중적조기효과.방법 2011년7월지2013년2월,공유25례부합수술괄응증환자(25관)재해방군총의원제일부속의원진행개량Colonna관절낭성형수술치료.기중남성7례,녀성18례;년령9.7 ～25.8세,평균17.8세;좌측12례,우측13례;체중지수15.6～29.6 kg/m2,평균20.9 kg/m2.관찰지표포괄:술전술후관관절활동도、Harris관관절평분、서안대략화맥극마사특대학골관절염지수(WOMAC)평분、시각모의량표(VAS)평분,술후환자대수술효과적만의도,이급말차수방시Severin분급、T(o)nnis골관절염분급.대술전、술후공능평개지표진행배대t검험.장소유환자안조수술치료시년령분위＜16세조(15례)화≥16세조(10례),채용성조자료방차분석비교량조환자말차수방시적공능평개지표급환자대수술만의도.결과 환자균획득수방,수방시간12 ～ 18개월,평균13.4개월.관관절활동도명현감소:술전평균380°,말차수방평균200°.술후9개월여술전비교,Harris관관절평분(78 ±9비84 ±15,t=2.107,P=0.046)급WOMAC공능평분(14.8±8.4비8.6±9.6,t=-2.657,P=0.014)차이균유통계학의의.재말차수방중소유평분균유명현개선,단차이무통계학의의.말차수방시＜16세조적VAS동통평분화대수술효과적만의정도명현우우≥16세조,VAS평분분별위1.1±0.8화2.8±1.4(F=12.810,P=0.002),수술만의도분별위89±17화66±22(F=7.535,P=0.012).술후Severin분급위:Ⅰ급21관、Ⅱ급l관、Ⅲ급2관、Ⅳ급2관;술후T(o)nnis골관절염정도,0급5관、1급12관、2급7관、3급1관.결론 대부분청소년단측관탈위적환자경개량Colonna관절낭성형술치료획득만의적복위화조기치료효과,술후유교장강복과정,저령조(＜16세)치료효과우우대령조(≥16세).통과엄격수술괄응증,정준수술조작기술여우화술후강복방안유망제고술후료효.
Objective To discuss the early clinical results and risk factors of modified Colonna capsular arthroplasty for young patients with unilateral hip dislocation.Methods From July 2011 to February 2013,25 cases (25 hips) of modified Colonna capsular arthroplasty for unilateral hip dislocation in the 1st affiliated hospital of People's Liberation Army General hospital was collected,including 7 males,18 females; aged 9.7-25.8 years,averaging 17.8 years; left 12 cases,right 13 cases; Body mass index ranged 15.6-29.6 kg/m2,averaging 20.9 kg/m2.Clinical indexes were collected,including:range of motion (ROM) of the hip,the Harris Hip Score (HHS),West Ontario and McMaster University Osteoarthritis Index (WOMAC),visual analogue scale (VAS) score before and after surgery,along with the satisfaction score of the surgery,Severin grades,and T(o)nnis osteoarthritis grades at last follow-up.Paired t-test was applied for the indexes before and after surgery,variances components analysis was applied for the satisfaction score and the function scores at last follow-up compared in 2 groups,aging at surgery ＜ 16 years (15 cases) and ≥ 16 years (10 cases).Results All cases were followed up for 12-18 months,mean 13.4 months.The average hip ROM decreased from 380° in average pre-surgery to 200° in average at last follow-up.Indexes decreased comparing 9 months follow-up to pre-surgery,HHS(78 ± 9 vs.84 ± 15,t =2.107,P =0.046),WOMAC function score(14.8 ±8.4 vs.8.6 ±9.6,t =-2.657,P =0.014) appeared statistically difference.Indexes increased at the last follow-up,showing no statistically difference.VAS and the satisfaction score were much better in patients ＜ 16 years group compared with ≥16 years group at last follow-up.VAS was 1.1 ±0.8 compared with 2.8 ± 1.4(F =12.810,P =0.002),whereas the satisfaction score was 89 ± 17 compared with 66 ± 22 (F =7.535,P =0.012).The last radiological follow-up resulted that,Severin grade Ⅰ 21 cases,grade Ⅱ 1 case,grade Ⅲ 2 cases,grade Ⅳ 2 cases,and the T(o)nnis osteoarthritis grade 0 with 5 cases,grade 1 with 12 cases,grade 2 with 7 cases,grade 3 with 1 case.Conclusions In this early follow up,the majority of patients who underwent modified Colonna capsular arthroplasty for their unilateral hip dislocation would obtained satisfactory results,but with long term recovery,and the younger group (＜ 16 years) with better clinical results than the elder group (≥ 16 years).With strict indications,exacted surgical techniques and optimized rehabilitation,the modified Colonna arthroplasty would have better clinical results.
