3DCT模拟手术辅助治疗大龄发育性髋关节脱位患儿既往手术后残余畸形

目的:通过3DCT观察大龄(≥8岁)发育性髋关节脱位(DDH)手术后残余畸形病理改变，模拟手术预判治疗效果，探讨多种手术方式综合治疗的经验体会。方法:回顾分析山东大学附属省立医院小儿骨科2012年7月至2017年6月综合运用多种截骨术治疗的大龄DDH治疗后残余畸形病例资料共27例35髋，手术时患儿年龄8岁至13岁9个月...

Treatment of residual deformity of developmental dislocation of the hip in elder children assisted with three-dimensional computed tomography simulating operation

Objective To observe the pathological changes of residual deformities of developmental dislocation of the hip(DDH)in elder children(≥8 years)with three-dimensional computed tomography(3DCT),predict the therapeutic effect by simulating operation and to summarize the experiences of comprehensive treatment of various surgeries.Methods Clinical data were retrospectively analyzed for 27 cases(35 hips)of residual deformity after multiple osteotomies in elder children with DDH from July 2012 to June 2017.The operative age was from 8 years to 13 years and 9 months.According to the Tonnis classification,the types wereⅠ(7 hips),Ⅱ(22 hips)andⅢ(6 hips).According to the Kalamchi&MacEwen classification of osteonecrosis of femoral head,the types wereⅡ(6 hips),Ⅲ(11 hips),Ⅳ(8 hips)and non-necrosis(10 hips).According to the Ponseti criteria,the grade of hip function wasⅡ(3 hips),Ⅲ(6 hips),Ⅳ(4 hips),Ⅴ(12 hips)andⅥ(10 hips).According to the modified Severin classification,the types wereⅡ(3 hips),Ⅲ(3 hips),Ⅳ(12 hips)andⅤ(7 hips).Full-length computed tomography(CT)was performed for bilateral pelvis-femurs.The corresponding osteotomy was simulated according to age and matching level of head and socket.Femoral head coverage and joint matching after osteotomy were observed postoperatively.The pre/post-operative changes in Reimer index and Sharp angle were compared by paired sample t-test and P<0.01 was considered statistically significant for evaluating the radiographic effect and joint function recovery during follow-ups.Radiographic effects were evaluated by the modified Severin classification and joint function by the Ponseti criteria.Results During a follow-up period of 13-36 months,Reimer index improved from(0.54±0.24)to(0.19±0.08)and Sharp angle gained from(53°±8°)to(38°±6°).And the differences were statistically significant(P<0.01).According to the modified Severin classification,the outcomes were excellent(5 hips,typeⅠ),decent(19 hips,typeⅡ)and fair(11 hips,typeⅢ).And the excellent-decent rate was 68%(24/35).According to the Ponseti criteria,the grade wasⅠ(17 hips),Ⅱ(11 hips)andⅢ(7 hips).And the excellent-decent rate was 80%(28/35).Conclusions Hip pain may be relieved and limping gaits improved by comprehensive applications of various surgeries assisted with 3DCT simulating operation for residual deformities after DDH operations in elder children.With a definite early efficacy,the method should be popularized in clinical practices.