摘要
[目的]研究骨盆Salter截骨术治疗发育性髋脱位时,截骨远端旋转方式对患儿髋臼前倾角的影响。[方法]回顾2002~2007年因发育性髋脱位而行骨盆Salter截骨治疗,并在随访中获得完整资料的患儿51例,其中女性45例,男性6例;手术时平均年龄4.6岁(2.1~7.2岁),根据骨盆CT平扫测量术前及术后1~2年髋臼前倾角差值,以差值定义髋臼前倾角变化情况。截骨远端旋转方式根据术中X线平片测量进行评估,分3个方向测量:向前移位通过测量患侧与健侧闭孔最长纵径比值获得;向外移位通过测量截骨处远近端最外侧之间距离与截骨平面全长的比值获得;向下移位通过测量截骨端向下成角的角度获得。手术前后髋臼前倾角改变采用t检验:所测得的3组数值与前倾角差值之间的关系采用多因素相关分析,采用SAS8.0软件包分析数据。[结果]本组病例结果提示,健侧髋关节髋臼前倾角在随访期内无显著性差异(P>0.05),而骨盆Salter截骨术可明显改变髋臼前倾角(P<0.05),术后髋臼前倾角减小,在三种旋转方式中,以闭孔纵径比值与前倾角差值显著相关(P<0.05),即向前移位引起的髋臼前倾角改变最明显;向外旋转与向下旋转程度与前倾角差值相关性不显著。[结论]骨盆Salter截骨明显改变了髋臼前倾角,使髋臼前倾角减小,术中向前旋转是引起前倾角减小的主要原因,其次为向外旋转,向下旋转对前倾角的影响最小。
[ Objective] To investigate the impact of the distal osteotomy fragment rotation on acetabular anteversion when using pelvic salter osteomy treatment for developmental dysplasia of the hip (DDH) . [ Methods ] Complete follow up data of 51 patients who were diagnosed as having DDH and treated with Salter osteotomy from 2002 - 2007 were reviewed. There were 45 females and 6 males with an average age of 4. 6 years ( range, 2. 1 to 7. 2 years) . Acetabular anteversion difference before and 1 -2 years after surgery was measured according to pelvic CT scans. Acetabular anteversion change was defined by the measured difference. Distal osteotomy fragment rotation direction was assessed by X -ray at operation. Forward movement was measured by ratio of the ipsilateral to contralateral obturator longitudinal diameter. Outward shift was measured according to the ratio of the distal fragment lateral move distance to the osteotomy total plane diameter. Downward movement was measured according to the angle between two osteotomy fragment plane. Acetabular anteversion change before and after surgery was verified by t test and the relationship between acetabular anteversion difference and three different rotation directions was tested used multi - factor correlation analysis. Analysis of data used SAS 8.0 package. [ Results ] The results suggested that contralateral hip acetabular anteversion had no significant difference in the follow - up period ( P 〉 0. 05 ), and Salter pelvic osteotomy could significantly decrease the acetabular anteversion (P 〈 0. 05) . The ratio of the ipsilateral to obturator longitudinal diameter was significantly correlated with acetabular anteversion difference ( P 〈 0. 05 ) . This demonstrated that the anteversion change caused by distal fragment forward rotation was most significanL There was no significant correlation in acetabular anteversion difference between outward and downward rotation. [ Conclusion ] Pelvic Salter osteotomy can significantly decrease acetabular anteversion. The decreased acetabular anteversion is attributable to the distal fragment forward rotation during surgery. And downward rotation has minimum impact on acetabular anteversion.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2009年第17期1281-1284,共4页
Orthopedic Journal of China
基金
国家自然科学基金项目资助(编号:30750011)