CAJ | 학술논문

目的比较单纯应用白体髂骨植骨与联合应用同骼生植骨对发育性髋关节脱位(developmental dislocation of the hip,DDH)患儿行髋臼截骨术的临床效果.方法回顾性分析2007年3月至2011年10月采用切开复位髋臼截骨术治疗的113例DDH患儿资料.根据髋臼截骨术后使用的植骨材料,分为白体髂骨植骨组(52例,60髋)与同骼生联合白体髂骨植骨组(61例,67髋).113例患儿髋关节Tonnis脱位分级均为Ⅱ～Ⅳ度.两组患儿性别、年龄、手术侧别、脱位分型、髋臼截骨方式及髋臼指数比较,差异均无统计学意义.分别于术后6周、3个月、6个月、1年与2年进行随访,分别比较两组患儿髋臼截骨区骨愈合情况、髋关节的影像学及功能恢复情况,并采用Lane、Severin及McKay标准进行评分.结果术后6周与术后3个月时Lane骨愈合评分,联合同骼生组分别为(6.4±1.3)分、(9.6±1.7)分,白体髂骨组分别为(4.7±1.5)分、(7.8±1.2)分,前者骨愈合情况明显优于后者,两组之间有差异;而术后6个月与术后1年时,联合固骼生组和白体髂骨组截骨区均基本达到骨性愈合,两组无差异.Severin标准髋关节影像学评价结果显示:联合同骼生组(优41髋、良22髋、可4髋)优良率为(94.0％,63/67)明显高于白体髂骨组(优28髋、良22髋、可10髋)的优良率(83.3％,50/60);白体髂骨组可的概率(16.7％,10/60)明显高于联合固骼生组(6.0％,4/67).McKay标准髋关节功能评价结果与影像学评价结果一致.结论固骼生作为一种新型的骨缺损修复材料,能在术后早期促进髋臼截骨区骨愈合,从而提高截骨区域抗压性.在DDH患儿行髋臼截骨术中联合应用固骼生植骨可以辅助获得满意的头臼对位关系及髋关节功能.
목적 비교단순응용백체가골식골여연합응용동격생식골대발육성관관절탈위(developmental dislocation of the hip,DDH)환인행관구절골술적림상효과.방법 회고성분석2007년3월지2011년10월채용절개복위관구절골술치료적113례DDH환인자료.근거관구절골술후사용적식골재료,분위백체가골식골조(52례,60관)여동격생연합백체가골식골조(61례,67관).113례환인관관절Tonnis탈위분급균위Ⅱ～Ⅳ도.량조환인성별、년령、수술측별、탈위분형、관구절골방식급관구지수비교,차이균무통계학의의.분별우술후6주、3개월、6개월、1년여2년진행수방,분별비교량조환인관구절골구골유합정황、관관절적영상학급공능회복정황,병채용Lane、Severin급McKay표준진행평분.결과 술후6주여술후3개월시Lane골유합평분,연합동격생조분별위(6.4±1.3)분、(9.6±1.7)분,백체가골조분별위(4.7±1.5)분、(7.8±1.2)분,전자골유합정황명현우우후자,량조지간유차이;이술후6개월여술후1년시,연합고격생조화백체가골조절골구균기본체도골성유합,량조무차이.Severin표준관관절영상학평개결과현시:연합동격생조(우41관、량22관、가4관)우량솔위(94.0％,63/67)명현고우백체가골조(우28관、량22관、가10관)적우량솔(83.3％,50/60);백체가골조가적개솔(16.7％,10/60)명현고우연합고격생조(6.0％,4/67).McKay표준관관절공능평개결과여영상학평개결과일치.결론 고격생작위일충신형적골결손수복재료,능재술후조기촉진관구절골구골유합,종이제고절골구역항압성.재DDH환인행관구절골술중연합응용고격생식골가이보조획득만의적두구대위관계급관관절공능.
Objective To compare the effect of application of autologous iliac alone and NovaBone combined with autologous iliac in the acetabular osteotomy of children with developmental dislocation of the hip (DDH).Methods Data of 113 cases of children with DDH who had undergone open reduction and acetabular osteotomy surgery from 2007 to 2011 were retrospectively analyzed.According to bone material using after acetabular osteotomy,the patients were divided into autogenous iliac bone graft group (52 cases,60 hips) and NovaBone combined with autologous iliac bone graft group (61 cases,67 hips).There were no statistical differences in gender,age,side,dislocation type,osteotomy and acetabular index between the two groups.The patients were evaluated by Lane's scoring criteria,Severin standards and McKay standards at 6 weeks,3 months,6 months,1-year and 2-year post-operation follow-up.The bone healing of acetabular osteotomy zone,radiography and function of hip were compared.Results 6 weeks and 3 months after operation,Lane bone healing score in NovaBone combined with autologous iliac bone graft group (6.4±1.3 points and 9.6±1.7 points respectively) was obviously superior to autogenous iliac bone graft group (4.7±1.5 points and 7.8±1.2 points respectively).And 6 months and 1 year after operation,the two groups were basically reached bone healing.The Severin standard results showed that the rate (94％,63/67) of "Excellent and Good" in NovaBone combined with autologous iliac bone graft group (excellent:41 hips,good:22 hips,Fair:4 hips) was significantly higher than the rate (83.3％,50/60) in autogenous iliac bone graft group (excellent:28 hips,good:22 hips,Fair:10 hips).The rate (16.7％,10/60) of "Fair" in autogenous iliac bone graft group was significantly higher than the rate (6.0％,4/67) in NovaBone combined with autologous iliac bone graft group.McKay standard results were consistent with the results of radiological evaluation.Conclusion As a novel bone defect repair material,NovaBone can promote early bone healing process of acetabular osteotomy areas.It also can improve the resistance of osteotomy area.NovaBone can get a satisfied result in acetabular osteotomy in children with DDH.