联合术式合并异体肌腱重建圆韧带治疗小儿发育性髋关节脱位

目的探讨联合术式合并异体肌腱重建圆韧带治疗小儿发育性髋关节脱位(DDH)的手术方法及疗效。方法对48例小儿DDH患者(56髋)行软组织松解、股骨上段截骨、Salter或Pemberton髂骨截骨及异体肌腱移植、重建圆韧带术治疗,测定并对比手术前后的AI、CE角等指标,采用Severin影像学及McKay临床疗效评价标准评价疗效。结果 AI由术前36.2°~58.1°降低至11.4°~21.3°,CE角由术前-10°~-50°提高至12°~45°,差异均有统计学意义(P0.05)。患儿均获随访,时间1~4年。根据Severin X线评定标准:优30髋(53.6%),良21髋(37.5%),可5髋(8.9%)。根据McKay临床疗效评定标准:优29髋(51.8%),良20髋(35.7%),可4髋(7.1%),差3髋(5.4%)。结论联合术式结合异体肌腱重建圆韧带治疗DDH有利于提高成功率、减少并发症,但须强调联合化及个体化原则。

Combined operation with round ligament allograft tendon reconstruction in treatment of chil-dren with developmental dysplasia of the hip

Objective To explore the operation method and curative effect using tendon allograft reconstruction of the round ligament in treatment of children with developmental dislocation of the hip （DDH）. Methods 48 eases of pe- diatric DDH patients （56 hips） were enrolled in our research. The soft tissue was released, and the femur bone was cut, Salter or Pemberton iliac bone resection was performed and tendon allograft was reconstructed for the treatment of round ligament. The preoperative and postoperative AI, CE angle were compared using Severin imaging and McKay clinical curative effect evaluation standard evaluation of curative effect. Results AI was reduced from 36. 2°- 58. 1° preoperatively to 11.4 ° - 21.3 ° postoperatively （ P 〈 0. 05 ）, CE angle was improved from - 10 ° - - 50 °preoperative- ly to 12° - 45 °postoperatively（ P 〈 0. 05 ）. The children had been followed-up for 1 - 4 years. According to Severin X-ray evaluation criteria, 30 hips （53.6%） were excellent, 21 hips （37. 5% ） were good, 5 hips （8.9%） were fair. McKay clinical curative effect evaluation： patients were excellent in 29 hips （51.8%）, good in 20 hips （35.7%）, fair in 4 hips （7. 1% ）, and poor in 3 hips （5.4%）. Conclusions Joint operation combined with allograft tendon round ligament reconstruction in the treatment of DDH has the advantage of increase the success rate and reduce complications, however, the principle of combined and individualized treatment is of great importance.