摘要
目的探讨Bernese截骨术治疗成人髋关节发育不良（developmental dysplasia of the hip,DDH）的疗效。方法回顾分析2012年8月-2014年4月,采用改良S-P入路Bernese截骨术治疗并获随访1年以上的16例成人DDH患者临床资料。男4例,女12例;年龄18~35岁,平均27.8岁。左髋6例,右髋10例。髋关节Harris评分为（81.2±5.4）分,疼痛视觉模拟评分（VAS）为（4.8±0.5）分。患侧髋臼外侧CE角（即股骨头中心点的垂线与髋臼外侧边缘的夹角）为（6.5±8.7）°,髋臼顶倾斜角为（25.6±5.9）°,股骨头超出指数为36.5%±6.5%。根据Tonnis骨关节炎分型,0期12例,Ⅰ期3例,Ⅱ期1例。结果手术时间90~135 min,术中出血量400~800 mL,术后10例输血200~600 mL,术后引流量100~300 mL,住院时间7~12 d。术后切口均Ⅰ期愈合。2例术后出现股外侧皮神经支配区感觉麻木。16例患者均获随访,随访时间12~26个月,平均20个月。X线片复查示,截骨端均骨性愈合,愈合时间12~16周,平均13.5周。随访期间无髋臼骨折、异位骨化、骨坏死、内固定物松动等并发症发生;骨关节炎均无进展,未见髋臼囊性变。末次随访时,患侧髋臼外侧CE角为（27.7±6.8）°、髋臼顶倾斜角为（16.2±4.8）°、股骨头超出指数为19.7%±5.3%,VAS评分为（0.8±0.3）分,髋关节Harris评分为（96.8±6.7）分,与术前比较差异均有统计学意义（P〈0.05）。结论对于成人DDH患者,Bernese截骨术可有效增加髋臼包容,改善关节功能,延缓骨关节炎进展,近期疗效良好。
Objective To investigate the effectiveness of Bernese osteotomy for the treatment of developmental dysplasia of the hip（DDH） in adults. Methods Between August 2012 and April 2014, 16 patients with DDH were treated with Bernese osteotomy by S-P approach, and the clinical data were retrospectively analyzed. There were 4 males and 12 females with an average age of 27.8 years（range, 18-35 years）. The left side was involved in 6 cases and the right side in 10 cases. The visual analogue scale（VAS） score was 4.8±0.5, and the Harris hip score was 81.2±5.4. The lateral center edge（CE） angle（the angle between the vertical center of the femoral head and the lateral edge of the acetabulum）was（6.5±8.7）°; the horizontal tilt angle was（25.6±5.9）°; and the femoral head extrusion index was 36.5%±6.5%.According to the Tonnis osteoarthritis classification, 12 hips were rated as Grade 0, 3 hips as Grade I, and 1 hip as Grade II. Results The operation time was 90-135 minutes; the intraoperative blood loss was 400-800 mL; 10 cases accepted blood transfusion and the amount of blood transfusion was 200-600 mL; the postoperative drainage volume was 100-300 mL; and the hospitalization time was 7-12 days. All the cases achieved primary healing of incision with no early complications. Two cases had numb in the lateral femoral cutaneous nerve innervating area. All patients were followed up12-26 months（mean, 20 months）. The X-ray examination showed osseous healing at osteotomy site, and the healing time was 12-16 weeks（mean, 13.5 weeks）. No acetabulum fracture, heterotopic ossification, osteonecrosis, and internal fixation loosening occurred during follow-up. No progression of osteoarthritis or acetabular cystic change was observed. At last follow-up, the lateral CE angle was（27.7±6.8）°; the horizontal tilt angle was（16.2±4.8）°; the femoral head extrusion index was 19.7%±5.3%; VAS score was 0.8±0.3; the Harris hip score was 96.8±6.7; and all showed significant differences when compared
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第7期831-834,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
安徽省自然科学基金资助项目(KJ2013A160)~~
