中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
9期
935-941
,共7页
边臻%朱振华%郭源%张建立
邊臻%硃振華%郭源%張建立
변진%주진화%곽원%장건립
髋脱位,先天性%截骨术%股骨头坏死
髖脫位,先天性%截骨術%股骨頭壞死
관탈위,선천성%절골술%고골두배사
Hip dislocation,congenital%Osteotomy%Femur head necrosis
目的：比较Salter截骨术与Pemberton截骨术治疗2~3岁发育性髋关节脱位（developmental dislocation of the hip，DDH）患儿的手术疗效。方法回顾性分析1998年1月至2008年12月接受Salter截骨术或Pemberton截骨术治疗的DDH患儿59例（84髋），男10例（14髋），女49例（70髋）；年龄2~3岁，平均（2.5±0.4）岁。全部病例行髋关节切开复位、骨盆Salter截骨或Pemberton截骨、股骨近端旋转短缩截骨术。术后采用McKay髋关节功能评价评估临床疗效，影像学评价采用Severin髋关节评级，统计两种截骨术Severin髋关节评级优良率和术后相关并发症的发生率。结果全部病例随访2~16年，平均（5.6±3.5）年。末次随访影像学Severin髋关节评级优58髋、良20髋、中4髋、差2髋，优良率为93%（78/84），其中Salter截骨术组优良率100%，Pemberton截骨术组优良率82%，差异有统计学意义（χ2=7.43，P=0.003）。末次随访时McKay髋关节功能评价满意率Salter截骨术组（100%）与Pemberton截骨术组（97%）的差异无统计学意义（χ2=1.56，P=0.39）。Pemberton组1例发生髋关节半脱位及早期退行性变，其余病例效果优良。18髋（21%，18/84）发生了程度不同的股骨近端发育障碍，其中Pemberton截骨术组10髋、Salter截骨术组8髋，两组股骨近端发育障碍发生率的差异无统计学意义（χ2=2.54，P=0.17）。结论髋关节切开复位、骨盆Salter截骨或Pemberton截骨、股骨近端旋转短缩截骨术是治疗2~3岁DDH患儿的有效方法，但采用Pemberton截骨术时应注意避免出现由于髋臼外缘吸收而导致的髋臼发育不良。
目的：比較Salter截骨術與Pemberton截骨術治療2~3歲髮育性髖關節脫位（developmental dislocation of the hip，DDH）患兒的手術療效。方法迴顧性分析1998年1月至2008年12月接受Salter截骨術或Pemberton截骨術治療的DDH患兒59例（84髖），男10例（14髖），女49例（70髖）；年齡2~3歲，平均（2.5±0.4）歲。全部病例行髖關節切開複位、骨盆Salter截骨或Pemberton截骨、股骨近耑鏇轉短縮截骨術。術後採用McKay髖關節功能評價評估臨床療效，影像學評價採用Severin髖關節評級，統計兩種截骨術Severin髖關節評級優良率和術後相關併髮癥的髮生率。結果全部病例隨訪2~16年，平均（5.6±3.5）年。末次隨訪影像學Severin髖關節評級優58髖、良20髖、中4髖、差2髖，優良率為93%（78/84），其中Salter截骨術組優良率100%，Pemberton截骨術組優良率82%，差異有統計學意義（χ2=7.43，P=0.003）。末次隨訪時McKay髖關節功能評價滿意率Salter截骨術組（100%）與Pemberton截骨術組（97%）的差異無統計學意義（χ2=1.56，P=0.39）。Pemberton組1例髮生髖關節半脫位及早期退行性變，其餘病例效果優良。18髖（21%，18/84）髮生瞭程度不同的股骨近耑髮育障礙，其中Pemberton截骨術組10髖、Salter截骨術組8髖，兩組股骨近耑髮育障礙髮生率的差異無統計學意義（χ2=2.54，P=0.17）。結論髖關節切開複位、骨盆Salter截骨或Pemberton截骨、股骨近耑鏇轉短縮截骨術是治療2~3歲DDH患兒的有效方法，但採用Pemberton截骨術時應註意避免齣現由于髖臼外緣吸收而導緻的髖臼髮育不良。
목적：비교Salter절골술여Pemberton절골술치료2~3세발육성관관절탈위（developmental dislocation of the hip，DDH）환인적수술료효。방법회고성분석1998년1월지2008년12월접수Salter절골술혹Pemberton절골술치료적DDH환인59례（84관），남10례（14관），녀49례（70관）；년령2~3세，평균（2.5±0.4）세。전부병례행관관절절개복위、골분Salter절골혹Pemberton절골、고골근단선전단축절골술。술후채용McKay관관절공능평개평고림상료효，영상학평개채용Severin관관절평급，통계량충절골술Severin관관절평급우량솔화술후상관병발증적발생솔。결과전부병례수방2~16년，평균（5.6±3.5）년。말차수방영상학Severin관관절평급우58관、량20관、중4관、차2관，우량솔위93%（78/84），기중Salter절골술조우량솔100%，Pemberton절골술조우량솔82%，차이유통계학의의（χ2=7.43，P=0.003）。말차수방시McKay관관절공능평개만의솔Salter절골술조（100%）여Pemberton절골술조（97%）적차이무통계학의의（χ2=1.56，P=0.39）。Pemberton조1례발생관관절반탈위급조기퇴행성변，기여병례효과우량。18관（21%，18/84）발생료정도불동적고골근단발육장애，기중Pemberton절골술조10관、Salter절골술조8관，량조고골근단발육장애발생솔적차이무통계학의의（χ2=2.54，P=0.17）。결론관관절절개복위、골분Salter절골혹Pemberton절골、고골근단선전단축절골술시치료2~3세DDH환인적유효방법，단채용Pemberton절골술시응주의피면출현유우관구외연흡수이도치적관구발육불량。
Objective The objective was to discussing the difference between the Pemberton osteotomy and Salter osteot?omy which performed in patients between the ages of 2 and 3 years who suffered from developmental dislocation of the hip (DDH). Methods A retrospective review of the results of operation treatment for DDH in 59 children (84 hips) from January 1998 to De?cember 2008 was conducted. There are 10 boys (14 hips) and 49 girls (70 hips). The age of the patients was between 2-3 years old at the time of treatment 2.5±0.4 years. Surgery consist of open reduction of the hip, capsulorraphy, shortening and derotational oste?otomy of proximal femur, and innominate osteotomy which include Pemberton osteotomy (33 hips), Salter osteotomy (51 hips). McKay and Severin modified criteria were used to assess the function and radiographic results of the hip. Results The average follow?up time was 5.6±3.5 years ranging from 2 to 16 years. According to Severin criteria at final follow?up, 78 hips (93%) had ex?cellent and good results;4 hips were fair and 2 hips poor result. The radiology results in Salter osteotomy were better than Pember?ton osteotomy (rate of excellent and good results 100%vs. 82%,χ2=7.43, P=0.003). According to the McKay criteria Salter osteoto?my and Pemberton osteotomy have no significant difference in latest follow?up (the satisfactory rate 100%vs. 97%,χ2=1.56, P=0.39). 18 hips (21%) had proximal femoral growth disturbance which 10 hips in Pemberton group, 8 hips in Salter group. There is no significant difference (χ2=2.54, P=0.17). Conclusion Open reduction, innominate osteotomy and proximal femoral osteotomy were effective procedures for the treatment of DDH in children between 2-3 years old. More attention should be taken in Pember?ton osteotomy to prevent the acetabular bony edge absorption.
