槽式髋臼扩大术治疗儿童髋关节发育不良

Slotted acetabular augmentation in children with hip dysplasia

目的介绍我院采用Staheli槽式髋臼扩大术(slotted acetabular augmentation,SAA)治疗儿童髋关节发育不良的体会.方法 1999年11月～2003年4月,对13例(14髋)6到15岁髋关节发育不良的患儿行SAA.其中轻度9髋,给予单纯SAA;重度3髋,1髋给予单纯SAA,2髋给予Salter+SAA;脑瘫性2髋,给予内收肌、髂腰肌、屈膝肌松解+SAA.结果所有病例均获随访.平均随访期19个月.根据疼痛、Trendelenburg征、关节活动度、中心边缘角(center edge angle,CEA)测定及并发症行综合评价,SAA总有效率达92.9%.结论槽式髋臼扩大术(SAA)特别适用于髋关节包容不好但仍较稳定的轻度髋关节发育不良病例,通过沿关节囊铺设松质骨塑形来达到髋臼的扩大和延伸,获得一个匹配的股骨头覆盖.对重度髋关节发育不良的病例,我们试行SAA联合骨盆截骨术进一步纠正髋关节的病理变化,使稳定性增加.脑瘫性髋关节发育不良,SAA能提供髋臼的过度矫正,在平衡肌力后行SAA能取得满意效果.

Objective To report our experience of slotted acetabular augmentation(SAA) procedure in 13 patients with hip dysplasia. Methods Of 14 hips treated, 9 had slight hip dysplasia underwent SAA alone. Three hips had severe hip dysplasia and were treated with Salter+SAA procedures. Two patients with cerebral palsy suffered from progressive subluxation. They underwent adductors, iliopsoas and hamstring released and SAA procedure. Results All patients were followed-up for 4-45 months (mean 19 months).Good or excellent results were achieved in ~92.9% . Unsatisfactory result in 1 patient was due to excessive width of the augmentation. Conclusions Augmentation of the deficient acetabular is effectively achieved by the SAA procedure. The results of SAA procedure is satisfactory especially considering the complexity and the severity of the pathology. SAA combined with other procedures can correct the pathologic anatomy more effectively and provide the necessary stability.