CAJ | 학술논문

目的：探讨早期切开复位骨盆Salter截骨术治疗发育性髋关节脱位的长期疗效及其影响因素。方法1992年9月至2002年10月接受切开复位骨盆Salter截骨术的发育性髋关节脱位患儿68例81髋，随访至骨骼发育成熟的45例52髋纳入回顾性研究。男9例，女36例；手术时年龄1.4~5.3岁，平均2.5岁。所有患儿术前均未接受其他治疗。34例38髋术前行骨牵引。评价末次随访时改良Severin影像学及McKay临床功能情况。分析股骨头坏死发生率。分析改良Sev?erin影像学分类结果不良与股骨头坏死发生的相关性，及Ⅱ型股骨头坏死的股骨头包容情况。结果随访9.7~19.2年，平均13.5年。随访时年龄12.3~22.3岁，平均15.6岁。McKay髋关节功能评价优良率84.6%（44/52）。Severin影像学标准优良率69.2%（36/52），未发生股骨头坏死髋关节的优良率为82.8%（24/29）。23髋（44.2%，23/52）发生股骨头坏死，其中Ⅱ型16髋。年龄、性别、脱位程度、单双侧及有无过度下压均与Severin结果不良及股骨头坏死无关。股骨头坏死是Severin结果为中或差的危险因素（P=0.0327）。而骨盆截骨术股骨头过度下压与严重型股骨头坏死可能有关（P=0.037）。发生Ⅱ型股骨头坏死与未发生股骨头坏死病例外侧CE角、Reimers指数的差异无统计学意义（P值分别为0.457与0.308）。结论切开复位骨盆Salter截骨治疗发育性髋关节脱位术后发生股骨头坏死的风险较高，其中以Ⅱ型最为常见，但多数不会引起进行性股骨头包容不良。骨盆截骨术中股骨头过度下压可能与严重型股骨头坏死有关。未发生股骨头坏死的病例影像学与功能结果比较满意。
목적：탐토조기절개복위골분Salter절골술치료발육성관관절탈위적장기료효급기영향인소。방법1992년9월지2002년10월접수절개복위골분Salter절골술적발육성관관절탈위환인68례81관，수방지골격발육성숙적45례52관납입회고성연구。남9례，녀36례；수술시년령1.4~5.3세，평균2.5세。소유환인술전균미접수기타치료。34례38관술전행골견인。평개말차수방시개량Severin영상학급McKay림상공능정황。분석고골두배사발생솔。분석개량Sev?erin영상학분류결과불량여고골두배사발생적상관성，급Ⅱ형고골두배사적고골두포용정황。결과수방9.7~19.2년，평균13.5년。수방시년령12.3~22.3세，평균15.6세。McKay관관절공능평개우량솔84.6%（44/52）。Severin영상학표준우량솔69.2%（36/52），미발생고골두배사관관절적우량솔위82.8%（24/29）。23관（44.2%，23/52）발생고골두배사，기중Ⅱ형16관。년령、성별、탈위정도、단쌍측급유무과도하압균여Severin결과불량급고골두배사무관。고골두배사시Severin결과위중혹차적위험인소（P=0.0327）。이골분절골술고골두과도하압여엄중형고골두배사가능유관（P=0.037）。발생Ⅱ형고골두배사여미발생고골두배사병예외측CE각、Reimers지수적차이무통계학의의（P치분별위0.457여0.308）。결론절개복위골분Salter절골치료발육성관관절탈위술후발생고골두배사적풍험교고，기중이Ⅱ형최위상견，단다수불회인기진행성고골두포용불량。골분절골술중고골두과도하압가능여엄중형고골두배사유관。미발생고골두배사적병례영상학여공능결과비교만의。
Objective To retrospectively review long?term results of developmental dislocation of the hip patients treated with open reduction and Salter pelvic osteotomy, and to analyze the potential risk factors. Methods Sixty?eight developmental dislocation of the hip cases (81 hips) were treated with open reduction and Salter pelvic osteotomy from September 1992 to Octo?ber 2002, 45 cases (52 hips) were followed up to skeletal maturity. None had undergone other treatment before the key surgery. Some cases received skeleton traction before surgery. The radiographic and functional results were assessed at last follow?up. The possible relevant factors for unsatisfactory outcome were analyzed. The correlation between type ⅡAVN and the coverage rate of the femoral head were evaluated. Results The mean age at surgery was 2.5 years (ranged from 1.4 to 5.3 years). At last follow?up, 44 hips (84.6%) had excellent or good functional results. 23 hips (44.2%) had avascular necrosis of varying severity, of which 16 hips were typeⅡ. There was significant relevance between the AVN severity and the Severin classification result (P=0.018). The"over correction"hips, that were overcorrected during surgery, were more likely to get severe type AVN ( P=0.037). There was no correlation between TypeⅡAVN with uncoverage according to CE angle and Reimers index (P=0.457, 0.308 respectively). Con?clusion 1) Satisfactory functional and radiographic results could be expected in developmental dislocation of the hip cases with?out AVN;2) High risk of AVN existed in the late diagnosised hips that underwent open reduction and Salter pelvic osteotomy, typeⅡwas the most common type;3) TypeⅡAVN was not a predictor for progressive femoral head coverage deficiency;4)"Over cor?rection"in Salter pelvic osteotomy was related with severe type AVN which should be avoided.