摘要
目的探讨应用髋臼周围截骨术治疗髋关节发育不良的初步临床结果。方法2002年2月至2008年2月，应用髋臼周围截骨术治疗髋关节发育不良患者53例（55髋），女51例，男2例；年龄13～51岁，平均25．5岁。术前髋部疼痛史1个月～6年，平均16个月。6例曾经接受过髋部手术。术前Wiberg CE角为-20°-15°，平均3°。根据Tonnis分型，术前轻度关节炎16例，中度1例。外展位头臼关系基本正常，25例有Shenton线分离。前13例取髂腹股沟入路，后40例（42髋）采用改良Smith—Petersen入路。6例同时行转子部内翻截骨。结果全部病例随访12-60个月，平均28个月。术后3个月均获骨性愈合。髋部疼痛症状明显改善或消失。Harris评分由术前平均77．4分提高至末次随访94．6分。术后髋关节活动度较术前减小，总活动度减小20°-60°，以屈曲活动为主。术后Wiberg CE角20°-50°，平均29°。5例出现跛行，主要由臀中肌无力造成，经功能锻炼后好转。18例出现股外侧皮神经损伤，2例出现骨盆环断裂，均与手术初期经验不足有关。无截骨不愈合、血管损伤、截骨进入髋关节等并发症。结论对年龄较轻的髋关节发育不良患者，髋臼周围截骨术可获得较满意的临床结果。该术式可多维矫正髋臼畸形，髋臼截骨块血供不受影响，骨盆环的稳定性得以保存，患髋可以早期活动。
Objective To report the preliminary results of treatment of developmental dysplasia of the hip （DDH） with periacetabular osteotomy. Methods From February 2002 to February 2008, 53 patients （55 hips） with DDH were treated with periacetabular osteotomy. 51 patients were females, 2 were males, with the average age of 25.5 years （ranged, 13 to 51 years）. The hip pain period before surgery varied from 1 month to 6 years （mean 16 months）. 6 patients had the history of hip surgery＇. The mean Wiberg CE angle was 3° （range, -20° to 15°）. According to Tonnis osteoarthritis classification, there were 16 cases in grade Ⅰ, 1 in grade Ⅱ. 25 patients had Shenton＇s line broken. The ilioinguinal approach was used in former 13 cases. The modified Smith-Petersen approach was used in later 40 cases. Intertrachanteric varus osteotomy was done simultaneously in 6 cases. Results The mean follow-up period was 28 months （ranged, 12 to 60 months）. Bone union was achieved in 3 months after surgery. The pain relieved in most of patients. The Harris hip score increased from 77.4 points （ranged, 68 to 87 points） preoperatively to 94.6 points （ranged, 70 to 100 points） post-operatively. The range of motion of the hip decreased 20°-60° after surgery. The mean CE angle increased to 29° （ranged, 20° to 50°） postoperatively. 5 patients had limp after surgery, mostly due to dysfunction of gluteus medius, and recovered after 6 months of exercises. 18 patients got lateral femoral cutaneous nerve injury. Two patients suffered pelvic ring broken and healed without affecting on hip function. No complication such as infection, vascular injury, sciatic neve injury happened in this series. Conclusion Satisfactory results can be obtained through periacetabular osteotomy in young patients with DDH. Periac- etabular osteotomy can correct the acetabular deformity in muhiplanar. No vascular impair in aeetabular fragment. The stability of the pelvic can be reserved. Early rehabilitation is allowed after surger
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第2期143-147,共5页
Chinese Journal of Orthopaedics
关键词
髋脱位
先天性
截骨术
髋臼
Hip dislocation, congenital
Osteotomy
Acetabulum
