摘要
目的探讨经髂腹股沟入路伯尔尼髋臼周围截骨术的中期随访结果。方法84例96髋接受经髂腹股沟入路伯尔尼髋臼周围截骨术,男6例,女78例;年龄11～46岁,平均27.6岁。髋关节发育不良87髋,Perthes病9髋。结果随访3.8～9.0年,平均6.0年。Harris髋关节评分从术前平均76.1分增加到末次随访92.7分;外侧CE角从8.7°增加到32.7°,前方CE角从-4.2°增加到36.4°,髋臼臼顶倾斜角从27.9°减小到9.4°。术前有66髋存在Shenton线不连续,术后为31髋;术前有76髋存在软骨下骨硬化,术后为34髋;术前有41髋存在软骨下骨囊变,术后为23髋,差异有统计学意义。骨关节炎表现改善或未进展者78髋;骨关节炎表现有进展者18髋,4髋进展为T＂nnis3级,其中3髋矫正不足,1髋截骨进入关节。主要并发症包括截骨矫正不足9髋,过度矫正17髋,截骨进入关节2髋,截骨块固定失败1髋,股神经麻痹1例,切口疝4例,股外侧皮神经永久性麻木8例,BrookerⅠ期异位骨化3例。结论经髂腹股沟入路伯尔尼髋臼周围截骨术治疗成人髋关节发育不良,可获得畸形矫正与功能改善;缓解髋臼周围硬化和囊变,使髋臼周围骨质再生,保持关节间隙,延缓骨关节炎进展。手术操作正确、髋臼矫正位置准确是其技术关键。
Objective To review the mid-term results of periaeetabular osteotomy through ilioinguinal approach in the initial group of patients undergoing this procedure. Methods 96 periaeetabular osteotomies in 84 patients were reviewed with an average clinical follow-up of 6.0 （3.8-9.0） years. There were 78 females, 6 males with an average age of 27.6 （11-46） years at the time of the operation. The preoperative diagnosis was developmental dysplasia in 87 hips, Legg-Calve-Perthes disease in 9 hips. The ilioinguinal approach was used in all the hips. Results The average Harris hip score increased from 76.1 points preoperatively to 92.7 points at latest follow-up. The average Wiberg angle improved from 8.7° to 32.7°. The average anterior CE angle improved from -4.2° to 36.4°. The average aeetabular index angle decreased from 27.9° to 9.4°. The incident of the break of Shenton＇s line decreased from 66 hips （69%） to 31 hips （32%）. The radiographs of the hips with preoperative changes in the perieartieular bone showed some evidence of regeneration, which was shown by a decrease in the subehondral sclerosis from 76 hips （79%） to 34 hips （35%）, a decrease in the appearance of cysts from 41 hips （43%） to 23 hips （24%）. The radiographic severity of osteoarthritis, according to the criteria of Tonnis, improved or did not aggravate in 78 hips （81%）, and progressed in 18 hips （19%）, including 4 eases changed into Tonnis Grade 3 because of undereorreetion in 3, and osteotomy entering the joint in 1. The major complications included undereorreetion in 9 hips, overeorreetion in 17 hips, osteotomy entering the joint in 2 hips, femoral nerve palsy （resolved after 1 year） in 1 hip, incision hernia in 4 hips, loss of fixation and refixation in the third day postoperatively in one ease. Learning curve was apparently observed. Conclusion The mid-term results in this initial group of patients treated with periaeetabular osteotomy through ilioinguinal approach show reliable radiographic correction of deformity and improvement of function. The periaeetabular osteotomy is a biologic solution to the dyplastie hips. It may result in regeneration of the periartieular bone and preservation of the joint space in condition that the proper execution of the procedure and the proper corrections were performed.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第7期499-504,共6页
Chinese Journal of Orthopaedics
关键词
髋脱位
先天性
截骨术
骨关节炎
Hip dislocation, congenital
Osteotomy
Osteoarthritis
