Bernese截骨联合骨软骨成形术治疗髋关节发育不良

目的 探讨Bernese截骨联合骨软骨成形术治疗髋关节发育不良的初步临床结果.方法 2007年5月至2009年4月,应用Bernese截骨联合骨软骨成形术治疗DDH患者9例,女6例,男3例;年龄16～38岁,平均23.5岁.术前髋部疼痛3-21个月,平均7.6个月.1例有髋部手术史.术前LCE角为-12°～15°,平均2.5°,外展位头臼关系基本正常.术前水平投照位摄片测量α角55°～71°,平均61.3°,撞击试验阳性5例.Tonnis分期0期2髋,I期6髋,II期1髋.采用改良Smith-Petersen入路,联合应用Bernese截骨和股骨头颈部骨软骨成形术.结果 全部病例随访18-45个月,平均28个月.术后髋部疼痛消失或明显改善.术后3个月截骨处骨愈合.Harris评分由术前平均65.3分提高至术后91.8分.术后LCE角为21°～41°,平均28.2°.α角32°～41°,平均37.6°,撞击试验阳性1例.关节活动度和Tonnis分期较术前无明显改变.股外侧皮神经损伤3例,髋臼后柱断裂1例,无股骨头坏死、股骨颈骨折等并发症.结论 对于年轻的髋关节发育不良合并股骨头颈部畸形的患者,Bernese截骨联合骨软骨成形术可获得满意的临床结果.该术式可联合矫正髋臼和股骨头颈部的畸形,未增加股骨头坏死和股骨颈骨折的风险.

Treatment of developmental dysplasia of hip with bernese periacetabular osteotomy and osteochondroplasty

Objective To investigatethe preliminary clinical results of the treatment of developmental dysplasia of hip （DDH） with Bernese periacetabular osteotomy and osteochondroplasty. Methods From May 2007 to April 2009, 9 patients with developmental dysplasia of hip were treated with periacetabular osteotomy and osteochondroplasty. There were 6 females and 3 males. The average age of the patients was 23.5 years old （range; 16- 38 years）. The hip pain before surgery lasted from 3 to 21 months （mean 7.6 months）. Only 1 patient had the history of hip surgery. The mean lateral CE angle was 2.5° （range; -12°-15°） preopevatively and the relationship between head and acetabulum abduction in extensive position was fair normal. The average alpha angle measured.in cross table lateral radiography was 61.3° （range; 55°-71°）. Impingement tests were positive in 5 cases. According to Tonnis osteoarthritis grades, there were 2 cases in grade 0, 6 cases in grade Ⅰ, 1 in grade Ⅱ. Both Bernese periacetabular osteotomy and osteochondroplasty were performed through the modified Smith-Petersen approach. Results The mean follow-up period was 28 months （range; 18-45 months）. Postoperative hip pain disappeared or significantly relieved. Bone union was achieved in 3 months after surgery. The Harris Hip Score increased from 65.3 points preoperatively to 91.8 points postoperatively. The mean LCE angle increased to 28.2° （range; 21°-41°） and the average alpha angle decreased to 37.6° （range; 32°-41°） postoperatively. Impingement test was still positive in 1 case. Neither the range of hip joint motion nor Tonnis osteoarthritis grades had been changed obviously postoperatively. 3 patients got lateral femoral cutaneous nerve injury. 1 patient suffered pelvic ring broken. No complications such as femoral head necrosis and femoral neck fracture happened. Conclusions Satisfactory clinical results can be obtained through Bernese periaeetabular osteotomy combined with osteochondroplasty in young patients with DDH and proximal femoral deformity. The combined surgerycan correct the proximal femoral deformity as well as the acetabular, and doesn＇t increase the risk of femoral head necrosis and femoral neck fracture.