改良Pemberton髋臼成形治疗发育性髋关节脱位术后髋臼发育变化的动态观察

Dynamic research on the development of the acetabulum after the improved arthroplasty treatment of developmental dislocation of hip

目的: 探讨改良Pemberton髋臼成形, 观察其对髋臼发育变化的影响, 尤其是对髋臼指数发育的影响。方法: 手术方式采用术前不牵引, 一期行髋关节联合术式(切开复位+粗隆下旋转截骨+改良Pemberton髋臼成形)矫正全部畸形, 其中髋臼的处理是在Pemberton的基础上进行术式改良。结果: 1年内随访髋臼发育变化, 并进行动态描述, 股骨头覆盖良好, 髋臼指数明显改善, 由术前(44±5)°减少至(17±4)°。结论: 采用联合术式治疗DDH,其中对浅而大的髋臼采用改良Pemberton髋臼成形术处理, 能够使脱位变形的髋臼形态结构基本接近, 股骨头的覆盖、髋臼指数的改变、CE角的测量都达到满意的程度。这表明本术式使髋臼指数得到充分纠正, 加大了对股骨头的包容, 改善了髋臼受力结构, 术后髋臼发育基本接近正常。

Objective:To explore improved arthroplasty of treating developmental dislocation of the hip(DDH),and observe dynamic development of the acetabulum after operation,expecially the change of the acetabular index.Method:Seventy-eight patients(107 hips)suffered DDH were treated by the improved arthroplasty with combination of open reduction,subtrochanteric rotational osteotomy and modified Pemberton arthroplasty.The results were observed by roentgenography with average follow-up clinical findings of 12 months.Result:There showed a good femoral head covering,and marked decrease of acetabular index(AI) which decreased from (44±5)° preoperatively to (17±4)° postoperatively in 12 months follow-up.Conclusion:The new treatment of DDH with combination of open reduction,subtrochanteric rotational osteotomy and modified Pemberton arthroplasty can obviously improve femoral head coverage and decrease the acetabulum index(AE),thus make acetabular development approach a basic normal one.