摘要
目的探讨幼儿及儿童期发育性髋关节脱位(DDH)实施Pemberton骨盆联合股骨近端截骨术后半脱位的风险因素。方法回顾性分析2004年1月至2007年12月间收治的随访10年以上、有完整资料的62例(79髋)实施Pemberton骨盆联合股骨近端短缩、内翻、去旋转截骨术DDH患儿的临床资料。术前年龄(4.28±2.13)岁,其中≤3岁23例(33髋),>3岁39例(46髋);Tönnis分级Ⅱ级16髋,Ⅲ级19髋,Ⅳ级44髋;单侧45例,双侧17例。采用Pearson列联系数分析性别、术前年龄、Tönnis分级、单/双侧和股骨头缺血性坏死(AVN)与术后半脱位及Mckay髋关节功能评定和Severin影像学结果的关联性。采用配对样本t检验比较术前、术后1年及末次随访时骨性髋臼指数、CE角和Reimers不稳定指数间的差异。结果本组术后随访(12.10±1.02)年。本组骨性髋臼指数术前为(37.76±10.65)°,术后1年为(5.04±3.76)°,末次随访时为(8.71±3.42)°;CE角术前为(-55.61±43.29)°,术后1年为(40.18±8.73)°,末次随访时为(33.58±8.75)°;Reimers不稳定指数术前为(73.14±28.11)%,术后1年为(4.41±3.86)%,末次随访时为(14.17±11.78)%,均恢复到正常范围。上述指标术后1年及末次随访与术前数据比较,差异均有统计学意义(P<0.05);且末次随访时Reimers不稳定指数与术后1年时比较,差异亦有统计学意义(P<0.05)。末次随访时,Mckay髋关节功能优良率为84.81%(67/79),Severin影像学优良率为75.95%(60/79)。Pearson列联系数的关联性分析结果显示,单/双侧、AVN和术后半脱位与Mckay功能评定具有关联性(列联系数分别为0.359、0.599、0.649,P<0.05);年龄、AVN和术后半脱位与Severin影像学结果具有相关性(列联系数分别为0.356、0.478、0.707,P<0.05)。本组有6髋(7.59%)在术后平均2.21年出现了程度不同的半脱位。Pearson列联系数的关联性分析结果显示,年龄、单/双侧、Tönnis分级和AVN与术后半脱位具有关联性(列联系数分别为0.254、0.289�
Objective To investigate the risk factors of recurrent subluxation after Pemberton and proximal femur osteotomy with developmental dysplasia of the hip(DDH)in infancy and childhood.Methods From January 2004 to December 2007,62 patients(79 hips)of DDH in infancy and childhood were treated with Pemberton and proximal femoral subtrochanteric shortening and varus and derotation individualized osteotomy were evaluated at a minimum follow up of 10 years.The average age was(4.28±2.13)years old before the operation,17 hips of bilateral dislocation and 45 hips of unilateral dislocation,23 patients(33 hips)were younger than 3 years and 39 patients(46 hips)were older than 3 years,according to Tönnis classification,16 hips,19 hips and 44 hips were graded asⅡ,ⅢandⅣrespectively.Pearson contingency coefficient was used to analyze the correlation between gender,age,Tönnis classification,unilateral/bilateral hip,avascular necrosis(AVN)and recurrent subluxation,Mckay clinical criteria and Severin radiographic classification.The paired sample t test was used to compare the Bony Acetabular Index,the Center-Edge Angle and the Reimers Index of preoperative,1 years after operation and the last follow-up.Results All cases were followed up for(12.10±1.02)years.Compared with preoperative parameters,1 year after operation and the last follow-up,the Bony Acetabular Index recovered from(37.76±10.65)°to(5.04±3.76)°to(8.71±3.42)°,and the Center-Edge Angle recovered from(-55.61±43.29)°to(40.18±8.73)°to(33.58±8.75)°,and the Reimers Index recovered from(73.14±28.11)%to(14.17±11.78)%to(14.17±11.78)%,the average value recovered to the normal range.There was significant difference between the Bony Acetabular Index,the Center-Edge Angle and the Reimers Index of 1 years after operation and the last follow-up,as compared with preoperative parameters(P<0.05).The Reimers Index was significantly different for patients in the 1 years after operation and the last follow-up(P<0.05).The good rate of hip function was 84.81%(67/79)accor
作者
韦宜山
刘万林
王海瑞
白锐
李岱鹤
赵振群
王勇
孙亮
孙超
娜木罕
Wei Yishan;Liu Wanlin;Wang Hairui;Bai Rui;Li Daihe;Zhao Zhenqun;Wang Yong;Sun Liang;Sun Chao;Na Muhan(Department of Pediatric Orthopaedics,the Second Affiliated Hospital,the Inner Mongolia Medical University,Huhehot 010030,China;Department of Orthopaedics,the Affiliated People's Hospital,the Inner Mongolia Medical University,Huhehot 010020,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第12期1083-1089,共7页
Chinese Journal of Pediatric Surgery
基金
国家自然科学基金面上项目(81341107)
内蒙古自治区自然科学基金面上项目(2013MS11106)。
关键词
髋脱位
截骨术
手术后并发症
Hip dysplasia
Osteotomy
Postoperative complications
