伯尔尼髋臼周围截骨术治疗成人髋关节发育不良

目的 探讨经Smith-Peterson和髂腹股沟入路髋臼周围截骨术早期治疗成人髋关节发育不良的短期临床结果.方法 自2007年8月至2011年6月采用伯尔尼髋臼周围截骨术治疗19例患者22髋,其中男4例4髋,女15例18髋,平均年龄26岁(14～39岁).术前、术后拍摄骨盆正位、患髋关节正侧位及患髋关节CT三维重建,测量髋臼的CE角(中心边缘角),AC角(髋臼臼顶倾斜角),Sharp's角,并给予患髋关节Harris评分.结果 所有患者术后股骨头的覆盖均得到明显改善,CE角由术前平均11.0° (-7°～22°)增加至平均24.4° (16°～38°),AC角由术前平均20.6° (7°～36°)减小至平均12.4° (4°～22°),Sharp's角由术前平均49.1° (43°～59°)减小至平均40.9° (24°～50°),患髋关节Harris评分由术前平均86.0分(80～92分)改善为平均96.9分(94～99分).平均随访1.7年(0.5-4年),19例患者(22髋)髋部疼痛症状减轻或消失.结论 伯尔尼髋臼周围截骨术能明显改善髋臼覆盖股骨头的情况,是治疗成人髋关节发育不良有效、安全的手术方式.

The bernese periacetabular osteotomy in the treatment of adult developmental dysplasia of the hip

Objective To analyze the short-term clinical effect of Bernese periacetabular osteotomy （PAO） through Smith-Peterson and ilioinguinal approaches to treat the DDH patients. Methods Totally 19 cases （22 hips） underwent Bernese PAO in our department from August 2007 to June 2011. There were 4 males （4 hips） and 15 females （18 hips）. The mean age was 26 years old （range; 14-39 years）. Pre- and post-operatively, The patients were required to do some imaging tests as pelvis ap, hip anteroposterior and lateral film of affected side and three-dimensional computed tomography, the imaging films were respectively measured with CE angle （centre-edge angle）, AC angle （acetabular index angle） as well as Sharp＇s angle and progressed Harris Scores. Results The covers of femoral head of all patients were improved obviously after operation. The mean CE angle was increased from 11.0° （range; -7°-22°） preoperatively to 24.4° （range; 16°-38°） postoperatively. The mean AC angle was decreased from 20.6° （range; 7°-36°） preoperatively to 12.4° （range; 40-22°） postoperatively. The mean Sharp＇s angle was decreased from 49.1° （range; 430-59°） preoperatively to 40.9° （range; 240-50°） postoperatively. The mean hip Harris scores was improved from 86.0 （range; 80-92） to 96.9 （range; 94-99）. The mean follow-up time was 1.7 years （range; 0.5-4 years）. Pain symptoms of 19 patients （22 hips） were relieved or disappeared. Conclusions The Bernese periacetabular osteotomy could improve the cover of the femoral head remarkably and it is an operative and safe method to treat adult DDH.