摘要
目的探讨髋臼周围截骨治疗成人髋关节发育不良的手术适应证及疗效。方法25例成人髋关节发育不良患者接受经改良Smith—Peterson入路的髋臼周围截骨术，女19例，男6例；年龄18-45岁，平均25．5岁。均为单侧发病，左侧14例，右侧11例。3例有既往手术史，2例Chari截骨术、1例Salter截骨术。髋关节骨关节炎Tisnnis0期13例、Ⅰ期9例、Ⅱ期3例。Shenton线不连续18例。髋臼外侧cE角4．57°±7.39°，前侧CE角0．95°±6．02°，髋臼顶倾斜角32．50°±5．96°，股骨头超出指数38．11％±5．70％，Harris髋关节评分（75．32±7．51）分。结果全部患者随访2．0-7．5年，平均4．5年。3例髋关节骨关节炎Tonnis Ⅰ期者改善为0期，2例Tonnis Ⅱ期者改善为I期，1例Tonnis Ⅰ期者进展为Ⅱ期。Shenton线不连续减少为10例。外侧CE角29．07°±5．81°，前侧CE角29．52°±4．51°，髋臼顶倾斜角19．17°±4．95°，股骨头超出指数24．20％±4．83％，Harris髋关节评分（84．88±4．88）分，与术前比较差异均有统计学意义。16例出现股外侧皮神经支配区感觉麻木，其中9例自行恢复，7例残留永久性麻木。1例出现髋关节周围BrookerⅠ型异位骨化。结论经改良Smith—Peterson入路行髋臼周围截骨治疗成人髋关节发育不良可有效增加髋臼包容，改善关节功能，阻止髋臼周围硬化和囊性变，保持关节间隙，延缓骨关节炎进展。
Objective To study the indications and mid-term outcomes of periacetabular osteotomy on adult patients of developmental dysplasia of the hip （DDH）. Methods Twenty-five adult patients with DDH underwent periacetabular osteotomies through modified Smith-Peterson approach. There were 19 females and 6 males with an average age of 25.5 years （range, 18-45）. Every patient had a single dysplasia hip, including 14 hips in the left, and the other 11 in the right. Three eases were operated formerly, 2 of them received Chaff osteotomy and 1 received Salter osteotomy. Before operation 13 hips were Tonnis Grade 0 osteoarthritis, 9 hips were Grade Ⅰ , 3 hips were Grade Ⅱ. The Shenton line of 18 hips was broken. The lateral center-edge angle was 4.570±7.39°, the anterior center-edge angle was 0.950±6.02°, the horizontal tilt angle was 32.500±5.96°, the femoral head extrusion index was 38.11%±5.70%, the Harris hip score was 75.32±7.51 points. Changes of the indexes mentioned above were observed during the period of follow-up. Results All patients were followed up for average 4.5 years （range, 2.0-7.5）. Compared with the preoperative radiographic severity at the latest follow-up, 3 hips of T/Snnis Grade Ⅰ improved to Grade 0, 2 hips of Grade Ⅱ improved to Grade Ⅰ , 1 hip of Grade I changed into GradeⅡ. The incident of the break of Shen- ton line decreased to 10 hips. The lateral center-edge angle improved to 29.07°±5.81°, the anterior centeredge angle improved to 29.52°±4.51°, the horizontal tilt angle decreased to 19.17°±4.95°, the femoral head extrusion index decreased to 24.20%±4.83%, the Harris hip score increased to 84.88±4.88 points, The major complication included 16 cases of lateral femoral cutaneous nerve palsy （7 cases of them didn＇t recover forever） and 1 ease of ectopic ossification of Brooker I . Conclusion Periaeetabular osteotomy through a modified Smith-Peterson approach were performed to the dysplasia hip of adults, it can increase congruence, improve hip function;
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第10期961-966,共6页
Chinese Journal of Orthopaedics
关键词
髋脱位
先天性
截骨术
髋臼
骨关节炎
髋
Hip dislocation, congenital
Osteotomy
Aeetabulum
Osteoarthritis, hip
