CAJ | 학술논문

目的通过评价儿童髋关节脱位莎氏手术复位后影像学改变与临床功能评价的相关性,探索髋关节发育不良术后后遗发育不良的表现和关节功能之间的联系,对患儿日常生活的影响,以及什么样的髋关节后遗表现才需要进一步治疗的问题.方法收集1994年1月至2000年12月间,因髋关节脱位在我院行开放复位,改良Zahradnicek手术,并接受随访的17例患儿,共26个髋关节,其中双侧髋关节病例9例,右侧髋关节病例4例,左侧髋关节病例4例.随访时间为12～20年,平均为15.6年.拍摄骨盆X线正位片,记录和评估Sharp角,外侧CE角,Shenton线连续性,髋臼深度和骨关节炎.按Harris评分评估记录患儿关节功能.采用Spearman检验评估髋关节残余发育不良畸形与骨关节炎之间的关系;采用Spearman检验评估髋关节残余发育不良畸形与临床功能Harris评分之间的关系;采用Spearman检验评估骨关节炎与临床功能Harris评分之间的关系.结果髋关节残余发育不良畸形与骨关节炎之间无相关性(R=0.360 0,P=0.155 8);髋关节残余发育不良畸形与临床功能Harris评分之间无相关性(R=-0.066 5,P=0.799 9);骨关节炎与临床功能Harris评分之间有相关性(R=-0.612 1,P=0.009 0).结论髋关节脱位复位术后中期随访结果,髋关节残余发育不良的严重程度并不决定关节功能的好坏,这一时期功能差的关节一般是其他原因导致的.但如影像学伴有骨关节炎表现时,关节功能是受影响的.医生除需要根据影像学改变决定治疗方案外,还需考虑对患儿的综合评估.
목적 통과평개인동관관절탈위사씨수술복위후영상학개변여림상공능평개적상관성,탐색관관절발육불량술후후유발육불량적표현화관절공능지간적련계,대환인일상생활적영향,이급십요양적관관절후유표현재수요진일보치료적문제.방법 수집1994년1월지2000년12월간,인관관절탈위재아원행개방복위,개량Zahradnicek수술,병접수수방적17례환인,공26개관관절,기중쌍측관관절병례9례,우측관관절병례4례,좌측관관절병례4례.수방시간위12～20년,평균위15.6년.박섭골분X선정위편,기록화평고Sharp각,외측CE각,Shenton선련속성,관구심도화골관절염.안Harris평분평고기록환인관절공능.채용Spearman검험평고관관절잔여발육불량기형여골관절염지간적관계;채용Spearman검험평고관관절잔여발육불량기형여림상공능Harris평분지간적관계;채용Spearman검험평고골관절염여림상공능Harris평분지간적관계.결과 관관절잔여발육불량기형여골관절염지간무상관성(R=0.360 0,P=0.155 8);관관절잔여발육불량기형여림상공능Harris평분지간무상관성(R=-0.066 5,P=0.799 9);골관절염여림상공능Harris평분지간유상관성(R=-0.612 1,P=0.009 0).결론 관관절탈위복위술후중기수방결과,관관절잔여발육불량적엄중정도병불결정관절공능적호배,저일시기공능차적관절일반시기타원인도치적.단여영상학반유골관절염표현시,관절공능시수영향적.의생제수요근거영상학개변결정치료방안외,환수고필대환인적종합평고.
Objective To explore the relationship between residual dysplasia of hip and functional outcomes after surgery for developmental dislocation of hip in children.Methods From January 1994 to December 2000,17 children (26 hips) were diagnosed as developmental dislocation of the hip and underwent modified Zahradnicek procedure at our hospital.The involved hip joints were bilateral (n =9),right-sided (n =4) and left-sided (n =4).The average follow-up period was 15.6 (12-20) years.The values of Sharp angle,acetabular depth and center-edge angle were measured while the integrity of Shenton line and radiological manifestations of osteoarthritis were assessed by pelvic radiograph.The functional outcomes of hip were assessed by the Harris questionnaire.The relationships between residual dysplasia of hip joint deformity and osteoarthritis,residual dysplasia of hip joint deformity and Harris score and osteoarthritis and Harris score were assessed by Spearman's test respectively.Results No correlation existed between residual dysplasia of hip joint deformity and osteoarthritis (R=0.360 0,P=0.155 8) or Harris score (R =-0.066 5,P =0.799 9).However,there was correlation between osteoarthritis and Harris score (R =-0.612 1,P =0.009 0).Conclusions Based on the results of mid-term follow-ups,severity of hip residual dysplasia is not a decisive factor for its function.Some other causes may contribute to poor function of involved hip.If osteoarthritis is detected on pelvic radiograph,joint function shall be affected.Proper treatment is selected according to radiological findings and comprehensive evaluations.