综合保髋手术治疗髋关节发育不良晚期病变远期疗效评价

目的:探讨Chiari截骨、血管束植入为基础的综合手术治疗髋关节发育不良晚期病变的远期疗效。方法:42例(61髋)髋关节发育不良晚期病变患者接受以Chiari截骨、血管束植入为基础术式的综合手术治疗。本组年龄27~42岁,平均36.1岁。61髋中行单纯Chiari骨盆截骨、股骨头内血管束植入术39髋,配合髋臼加盖术16髋,配合股骨近端旋转截骨术2髋,配合髋臼加盖术及股骨近端旋转截骨术4髋。结果:本组平均随访时间8.4年,最后随访时,5例5髋已行人工髋关节置换,其他37例56髋Harris评分术前平均58分,术后平均83分,疗效优良43髋(76.8%)。CE角:术前平均8.7°,术后平均28.5°。股骨头覆盖指数:术前平均61.4%,术后平均83.2%。结论:该综合手术方法对髋关节发育不良晚期病变可以显著缓解临床症状,改善髋关节功能,提高患者生活质量,大大延缓人工全髋关节置换术的时间。

Long-term effect evaluation on combination operations of Chiari osteotomy and vascular bundle graft for the treatment of late changes of congenital hip dysplasia

Objective:To evaluate the long-term effect of combination operations of Chiari osteotom and vascular bundle graft in the treatment of late changes of congenital hip dysplasia.Methods:Forty-two patients(61 hips)with late changes of congenital hip dysplasia were treated with combination operations of Chiari osteotomy and vascular bundle graft.The age of the patients ranged from 27 to 42 years,with an average of 36.1 years. Among 61 hips,39 hips were treated with simple Chiari osteotomy and vascular bundle graft operation,16 hips were treated with above operation combined with acetabuloplasty by using shelf,2 hips were treated with above operation combined with proximal femoral rotational osteotomy,and 4 hips were treated with above operation combined with both shelf and femoral rotational osteotomy.Results:All the patients were followed up from 6 to 12 years,with an average of 8.4 years.At the last follow-up, total hip replacement was performed in 5 patients(5 hips).The mean Harris hip score of the other 37 cases(56 hips)was 83,much higher than 58 before the operation.Forty-three hips(76.8%)had excellent and good results.Radiological evaluation indicated that mean CE angle was improved from 8.7° (pre-op) to 28.5° (post-op) and mean AHI from 61.4% to 83.2%.Conclusion: This methods is effective to significantly relieve clinical symptoms of patients with late changes of congenital hip dysplasia,improve hip function,increase quality of life and postpone total hip replacement.