髂臼成形骨盆截骨术治疗幼儿发育性髋脱位的疗效

目的探讨髂臼成形(Pemberton)骨盆截骨术治疗幼儿发育性髋脱位(DDH)的疗效。方法对54例DDH患儿采用Pemberton骨盆截骨术治疗。记录临床随访结果和髋关节解剖结构参数。末次随访时,采用Mckay评估标准评价髋关节功能,采用Severin标准评价髋关节形态和复位情况。结果单侧DDH患儿均获得9个月随访;双侧DDH患儿先手术侧获15~18个月随访,后手术侧获9个月随访。术后3个月,患儿股骨、髋臼截骨处均愈合,无重要血管神经损伤、截骨处明显感染等并发症发生。术后6个月、末次随访时髋关节各解剖结构参数均较术前改善明显(P<0.05);与术后6个月相比,末次随访时,骨性髋臼指数(AI)和髋臼深度逐渐增大(P<0.05),中心边缘角(CE角)、髋臼顶宽度和Reimers不稳定指数逐渐减小(P<0.05),髋关节各解剖结构参数已逐步接近同龄正常儿童。末次随访时,单侧DDH患儿患侧的髋臼顶宽度、臼头指数均明显高于健侧(P<0.05),AI、CE角、髋臼深度患侧与健侧比较差异均无统计学意义(P>0.05)。末次随访时,4例髋臼Y形软骨已闭合,其中1例Y形软骨早闭;采用Mckay评估标准评价髋关节功能的优良率为86.67%;采用Severin标准评价髋关节形态和复位情况的优良率为83.33%。结论Pemberton骨盆截骨术可以有效纠正DDH,修复髋关节功能,促进骨骺生长及患儿康复,效果显著。

Therapeutic effect of Pemberton pelvic osteotomy for infantile developmental dislocation of the hip

Objective To investigate the effect of Pemberton pelvic osteotomy in the treatment of developmental dislocation of the hip(DDH).Methods Pemberton pelvic osteotomy was performed in 54 children with DDH.Clinical follow-up results and anatomical structure parameters of the hip joint were recorded.At the last follow-up,hip function was evaluated by using Mckay evaluation criteria,and hip morphology and reduction situation were evaluated by using the Severin evaluation criteria.Results The children of unilateral DDH were followed up for 9 months;and for the children of bilateral DDH,the first sugery side were followed up for 15~18 months,the later sugery side were followed up for 9 months.At 3 months after the operation,the femoral and acetabular osteotomy sites of the children were healed,and there were no important vascular and nerve injury or obvious infection at the osteotomy site and other complications.At 6 months after operation and the last follow-up,the anatomical structure parameters of hip joint were significantly improved,compared with those before operation(P<0.05).At the last follow-up,acetabular index(AI)and acetabular depth increased gradually than those of postoperative 6 months(P<0.05),while center-edge(CE)angle,acetabular top width and Reimers instability index decreased gradually(P<0.05),the anatomical structure parameters of hip joint gradually approached that of normal children at the same age.At the last follow-up,for the unilateral DDH,the acetabular top width and acetabular head index of the affected side were significantly higher than those of the healthy side(P<0.05).There were no significant differences in AI,CE angle and acetabular depth between the affected side and the healthy side(P>0.05).At the last follow-up,the Y-shaped cartilage of the acetabulum was closed in 4 cases,including 1 case with premature closure.The excellent and good rate of hip joint function evaluated by Mckay evaluation criteria was 86.67%.The excellent and good rate of hip joint morphology and reduction evaluated by Severin criterion was 83.33%.Conclusions Pemberton pelvic osteotomy can effectively correct DDH,repair the function of the hip joint,promote the growth of epiphysis and the recovery of children,with remarkable effect.