CAJ | 학술논문

目的：探讨8岁以上儿童发育性髋关节脱位的术式选择及近期疗效。方法回顾性分析2006年1月至2012年12月手术治疗的8~13岁发育性髋关节脱位患儿94例112髋，男18例，女76例；年龄8.2~13.6岁，平均9.8岁。依据年龄将其分为8~9岁组、10~11岁组和12~13岁三组。髋关节脱位T?nnis分型Ⅱ型34髋、Ⅲ型29髋、Ⅳ型49髋。全部病例均行髋关节切开复位、关节囊紧缩，股骨近端短缩去旋转截骨，髋臼侧采用Pemberton截骨66髋、Salter截骨30髋、伯尔尼髋臼周围截骨3髋、三联截骨5髋、Chiari骨盆内移截骨8髋。术后采用McKay髋关节功能评价和Severin髋关节影像学评级对比不同年龄段、不同脱位程度组患儿治疗效果的差异。结果全部病例随访1~7年，平均2.3年。末次随访时McKay髋关节功能为优22髋、良53髋、中32髋、差5髋，优良率67%（75/112）。（1）不同T?nnis分型组McKay髋关节功能评级的差异有统计学意义，其中Ⅳ型组McKay髋关节功能优良率低于Ⅱ型和Ⅲ型，而Ⅱ型和Ⅲ型之间的差异无统计学意义；不同T?nnis分型组Severin髋关节影像学评级的差异无统计学意义。（2）8~9岁组McKay髋关节功能优于其他年龄组，12~13岁组Severin影像学评级较其他年龄组差。结论髋关节切开复位、股骨近端截骨及髋臼侧截骨是治疗大龄儿童发育性髋关节脱位的有效方法。手术疗效与切开复位时的年龄和脱位程度有关：T?nnisⅡ、Ⅲ型患儿术后髋关节功能优于Ⅳ型，年龄＜10岁的患儿术后髋关节功能和影像学评级较好。
목적：탐토8세이상인동발육성관관절탈위적술식선택급근기료효。방법회고성분석2006년1월지2012년12월수술치료적8~13세발육성관관절탈위환인94례112관，남18례，녀76례；년령8.2~13.6세，평균9.8세。의거년령장기분위8~9세조、10~11세조화12~13세삼조。관관절탈위T?nnis분형Ⅱ형34관、Ⅲ형29관、Ⅳ형49관。전부병례균행관관절절개복위、관절낭긴축，고골근단단축거선전절골，관구측채용Pemberton절골66관、Salter절골30관、백이니관구주위절골3관、삼련절골5관、Chiari골분내이절골8관。술후채용McKay관관절공능평개화Severin관관절영상학평급대비불동년령단、불동탈위정도조환인치료효과적차이。결과전부병례수방1~7년，평균2.3년。말차수방시McKay관관절공능위우22관、량53관、중32관、차5관，우량솔67%（75/112）。（1）불동T?nnis분형조McKay관관절공능평급적차이유통계학의의，기중Ⅳ형조McKay관관절공능우량솔저우Ⅱ형화Ⅲ형，이Ⅱ형화Ⅲ형지간적차이무통계학의의；불동T?nnis분형조Severin관관절영상학평급적차이무통계학의의。（2）8~9세조McKay관관절공능우우기타년령조，12~13세조Severin영상학평급교기타년령조차。결론관관절절개복위、고골근단절골급관구측절골시치료대령인동발육성관관절탈위적유효방법。수술료효여절개복위시적년령화탈위정도유관：T?nnisⅡ、Ⅲ형환인술후관관절공능우우Ⅳ형，년령＜10세적환인술후관관절공능화영상학평급교호。
Objective To investigate the treatment and clinical outcomes in developmental dislocation of the hip in chil?dren above 8 years old. Methods We retrospectively reviewed the results of operation treatment for developmental dislocation of the hip in 94 children (112 hips) from 2006 to 2012. The age of the patients ranged from 8.2 to 13.6 years at the time of treatment, with an average age 9.8 years. In 94 patients, there are 18 males and 76 females. The patients were classified into three group based on the age at time of operation:Group 8-9 years old, Group 10-11 years old, Group 12-13 years old. The dislocation of hip was classified by T?nnis classification system:gradeⅡ34 hips, gradeⅢ29 hips, gradeⅣ49 hips. Surgery was performed in all the patients. The procedures consisted of open reduction of the hip, capsulorraphy, shortening and derotational osteotomy of proxi?mal femur, and acetabular osteotomy which include Pemberton osteotomy (66 hips), Salter osteotomy (30 hips), Ganz osteotomy (3 hips), Triple osteotomy (5 hips) and Chiari osteotomy (8 hips). McKay and Severin modified criteria were used to assess the func?tion and radiographic results of the hip. Results The average follow?up was 2.3 years ranged from 1 to 7 years. According to McKay modified criteria at final follow?up, 75 hips (67%) had excellent (22 hips) and good (53 hips) clinical results, 32 hips (29%) were fair and 5 hips (4%) were poor. According to the Severin criteria, the outcomes of T?nnis grade Ⅳgroup was significantly worse than T?nnis gradeⅡ,Ⅲgroup. There is no significant differences between T?nnisⅡandⅢtype groups. If the patients were classified by age at time of operation, the function of group 8-9 years old was significantly better than others group according to the McKay criteria; the group 12-13 years old was significantly worse than others group according to Severin criteria. Conclu?sion Open reduction with proximal femoral osteotomy and acetabular osteotomy was an effective procedure for the treatment of developmental dislocation of the hip in children above 8 years old. The surgical results were related to the age at time of treatment and T?nnis classification system; low dislocation (T?nnis Ⅱ, Ⅲ) and young age (younger than 10 years old) had better function and radiographic results compared with high dislocation (T?nnisⅣ) and elder age group.