摘要
目的通过CT三维重建研究Salter骨盆截骨术对发育性髋关节脱位（developmental dislocation of the hip,DDH）髋臼形态和方向的影响及其相关性。方法以2013年1月-2015年1月收治并符合选择标准的51例单髋DDH女性患儿作为研究对象。年龄1岁6个月-5岁,平均2岁5个月。均行单侧髋关节切开复位、Salter骨盆截骨、股骨短缩旋转截骨、髋＂人＂字石膏外固定术。术前及术后1周行CT及三维重建检查,测量手术前后患髋前髋臼指数（anterior acetabular index,AAI）、后髋臼指数（posterior acetabular index,PAI）、髋臼前倾角（acetabular anterversion angle,AAA）、轴面髋臼指数（axial acetabular index,Ax AI）,以及术后截骨远端骨块向前、向下、向外旋转的距离。比较手术前后AAI、PAI、AAA及Ax AI,取差异有统计学意义的指标,计算手术前后差值,采用Spearman相关分析其与向前、向下、向外旋转距离的相关性。结果 AAI、PAI及AAA手术前后比较,差异均有统计学意义（P〈0.05）;Ax AI手术前后比较,差异无统计学意义（t=0.878,P=0.384）。AAI、PAI及AAA手术前后差值分别为（4.518±4.601）、（4.219±6.660）、（3.919±4.389）°。术后截骨远端骨块向外、向下、向前旋转距离分别为（0.420±0.339）、（2.440±0.230）、（0.421±0.311）cm。各向旋转距离与AAI手术前后差值均相关（P〈0.05）,其中向外旋转距离与其高度相关（r=0.981）。向外、向前旋转距离与PAI、AAA手术前后差值相关（P〈0.05）,向下旋转与其无相关性（P〉0.05）,其中向前旋转与AAA手术前后差值高度相关（r=0.841）。结论 Salter骨盆截骨术可使DDH髋臼前方弧度增大而后方弧度减小,在增加髋臼前方覆盖的同时牺牲了后方覆盖;同时改变了髋臼方向,使髋臼前倾角减小,但不能改变髋臼深度。Salter骨盆截骨术改变髋臼前后弧度的主要因素是向外和向前旋转,改变髋臼方向的主要因素是向前旋转。
Objective To investigate the impact of the Salter innominate osteotomy on the acetabular morphology and direction and the relationship between them in children with developmental dislocation of the hip（DDH） by three-dimensional CT. Methods Between January 2013 and January 2015, 51 patients with unilateral DDH were treated. All patients were females with an average age of 2 years and 5 months（range, one year and 6 months to 5 years）. All the patients underwent open reduction of the hip, Salter innominate osteotomy, proximal femoral osteotomy, and hip cast immobilization for treatment. The data of three-dimensional CT before surgery and at 1 week after surgery were measured and collected as follows： the anterior acetabular index（AAI）, posterior acetabular index（PAI）, axial acetabular index（Ax AI）, acetabular anteversion angle（AAA） of the acetabulum, and the distances of the forward, outward, and lateral rotation of the distal osteotomy fragments. The differences of AAI, PAI, Ax AI, AAA between before and after surgeries were compared and the difference values of the data with significant difference results were calculated. The relationship between the difference values and the distances of three different rotation directions before and after surgeries were tested by Spearman correlation analysis. Results There were significant differences in the AAI, PAI, and AAA between before and after surgery（P〈0.05）, but no significant difference was found in the Ax AI between before and after surgery（t=0.878, P=0.384）. The difference values of AAI, PAI, and AAA were（4.518±4.601）,（4.219±6.660）, and（3.919±4.389）° respectively. The distances of the outward, lateral, and forward rotation of the distal osteotomy fragments after surgery were（0.420±0.339）,（2.440±0.230）, and（0.421±0.311） cm. There was a significant correlation between the three different rotation directions and AAI difference（P〈0.05）, especialy the outward rotation（r=0.981）. There was a correlation between the outward, forward rotation and PAI, AAI differences（P〈0.05）, and no significant correlation between the lateral rotation and PAI, AAA was found（P〈0.05）. There was a significant correlation between the forward rotation and AAA difference（r=0.841）. Conclusion Salter innominate osteotomy can increase the curvature of the anterior wall of the acetabulum in DDH, but reduce the curvature of the rear wall. At the same time, it can also change the direction of the acetabulum, significantly decrease the acetabular anteversion, but it can not change the depth of the acetabulum. The main factors of the curvature change after Salter innominate osteotomy of DDH is attributable to outward rotation, followed by forward rotation, and the main factor of the acetabular direction change is attributable to forward rotation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第11期1332-1336,共5页
Chinese Journal of Reparative and Reconstructive Surgery
作者简介
通信作者：刘敏，主任医师，硕士生导师，研究方向：小儿矫形外科，E．mail：huaxilm@163．com
