Pemberton截骨术治疗大龄儿童髋关节发育不良的疗效分析

Evaluation of Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children

[目的]探讨Pemberton截骨术治疗大龄儿童髋关节发育不良的疗效。[方法]应用Pemberton截骨术治疗大龄儿童髋关节发育不良共21例（24髋）。手术时平均年龄为9岁7个月（7～13岁6个月）。术中根据股骨头脱位高度、前倾角和颈干角联合行股骨短缩截骨、去旋转截骨和近端内翻截骨术。[结果]术后平均随访5年5个月（4～10年），有18髋达到McKay临床功能评价的优或者良；所有髋关节的髋臼指数（或者Sharp角）、CE角和头臼指数均得到明显改善，平均值恢复到正常范围；18髋的X线片评价达到Severin影像学评价的Ⅰ～Ⅱ级。新出现和在原基础上加重的髋关节活动受限9例，髋关节半脱位4例，股骨头缺血性坏死6例，髋关节骨关节炎3例。[结论]Pemberton截骨术治疗大龄儿童髋关节发育不良大部分可以得到一个临床功能优良、中心复位或包含良好的髋关节，同时需要注意减少术后并发症的发生。

[ Objective ] To evaluate the outcome of the Pemberton osteotomy for the treatment of developmental dysplasia of the hip （DDH） in older children. [ Method] There were 21 children （24 hips） older than 7 years in our study , who received the Pemberton osteotomy, and combined with femoral shortening, derotational or varus osteotomies according to the level of dislocation, anteversion and neck - shaft angle of the femur. The average age at operation were 9 years and 7 months （ range： 7- 13.5 years） . [ Result] The mean follow - up were 5 years and 5 months. Eighteen hips achieved the excellent or good clinical results according to the MeKay＇s clinical criteria, All of the hips got improvements of the Aeetabular Index, Sharp Aeetabular Angle, Center - Edge Angle and Aeetabular Head Index. The average results were in the normal range, Eighteen hips got Ⅰ or Ⅱclass of the Severin＇ s radiographic classification. However, 9 hips were limited in the range of movement. Four hips got subluxation, Six hips developed avaseular necrosis of the femoral head. Three hips got improved osteoarthritis. [ Conclusion] The Pemberton osteotomy for the treatment of developmental dysplasia of the hip in older children can mostly achieve well - used, contained or concentric reduction hips, meanwhile need to reduce the complications.