经髋臼基底三联截骨术治疗青少年髋臼发育不良

Periacetabular triple osteotomy for the treatment of adolescence acetabular dysplasia

目的:介绍经髋臼基底三联截骨术治疗青少年髋臼发育不良.方法:2000年3月～2004年2月改进Tonnis术式,设计经髋臼基底三联截骨治疗22例患者.术前X线片显示:CE角为-25～15°,平均8.4°;Sharp角为45～70°,平均58.6°:臼头指数为31%～76%,平均61.4%;ACP角为100～170°,平均139.8°.CT片示:髋臼前CE角大于正常,髋臼前断面角和前倾角小于正常.CT三维重建示:前、后外侧壁边缘角,外侧髋臼倾斜角均大于正常,水平面髋臼旋转角小于正常.结果:16例(16髋)有12～30个月(平均20个月)的随访结果.X线片示:CE角平均32.6°(15～52°),比术前增大约25°;Sharp角平均41.5°(38～46°),减小约18°;臼头指数平均81.6%(69%～89%),增大约20%;ACP角平均171.1°(140～180°),增大约31°.CT示:髋臼前CE角和前倾角变小,髋臼前断面变大.CT三维重建示:髋臼前、后外侧壁边缘角变小,外侧髋臼倾斜角变小,水平面髋臼旋转角变大.结论:经髋臼基底三联截骨术治疗青少年髋臼发育不良能够获得满意疗效.

Objective:To introduce the periacetabular triple osteotomy for the treatment of adolescence acetabular dysplasia.Method:From March 2000 to February 2003,the authors had modified Tǒnnis triple pelvic osteotomy and designed periacetabular triple osteotomy creatively,22 patients with acetabular dysplasia were operated upon with the new therapy.Computed radiography preoperation showed:CE angle was -25～15° with an average of 8.4°;Sharp angle 45～70°,averaged 58.6°;AHI 31%～76%,averaged 61.4%;ACP angle 100～170°,averaged 139.8°.Shenton's line broken.Computed tomography showed:ACEA justo major;AASA and AAVA justo minor.Three dimensional computed tomography showed:ALAL,PLAL and LAI justo major;TR justo minor.Result:Sixteen cases(16 hips)were followed up for 12～30 months,with an average of 20 months.Computed radiography showed:Average CE angle was 32.6°(15～52°),increased about 25°;average Sharp angle was 41.5°(38～46°),decreased about 18°;average AHI was 81.6%(69%～89%),increased about 20%;average ACP angle was 171.1°(140～180°),increased about 31%.Computed tomography showed:ACEA and AAVA decreased,AASA increased.Three dimensional computed tomography showed:ALAL,PLAL and LAI decreased,TR increased.Conclusion:The periacetabular triple osteotomy is a very safe and efficient procedure for the treatment of adolescence acetabular dysplasia.