改良髋臼旋转截骨术治疗髋臼发育不良

Modified rotational acetabular osteotomy for the treatment of adult acetabular dysplasia

[目的]研究改良的髋臼旋转截骨术治疗髋臼发育不良的方法及有效性。[方法]自2002年10月～2007年8月采用改良的Ninomiya方法治疗27例髋臼发育不良的患者,其中男3例3髋,女24例27髋;平均年龄29.4岁(15～42岁)。术前、术后拍摄骨盆正位、双髋侧位及外展位像,测量髋臼的CE角(中心边缘角)和AC角(臼顶倾斜角),记录髋关节旋转中心及Shenton氏线变化、骨关节炎的严重程度并进行随访,行髋关节Harris评分并进行评价。[结果]所有患者截骨术后股骨头覆盖均得到改善,CE角由术前的3.2°(-15°～15°)矫正为28.5°(20°～40°),AC角由术前的26.6°(15°～38°)矫正为3.9°(0°～12°),髋臼旋转中心内移率为63.3%(19/30),Shenton氏线不连续率由67%降为23%。平均随访4.2年(1.5～7年),1髋失随访,28髋疼痛减轻、骨关节炎得到控制,1髋疼痛加重,Harris评分由术前82.7分(67～96分)改善为97.8分(87～100分)。术后2例患者出现耻骨纤维愈合,1例出现耻骨下支应力骨折,无截骨块或大粗隆不愈合病例。[结论]改良的髋臼旋转截骨术能有效地治疗髋臼发育不良,是一种有效、安全的手术方式。

[Objective]To investigate the method and efficiency of operative modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia. [Methods]Twenty-seven patients with 30 hips with acetabular dysplasia were treated with modified rotational acetabular osteotomy. The study group consisted of three men with 3 hips and twenty-four women with 27 hips,the average age of the patients was 29.4 years（range,fifteen to forty-two years ）.The anteroposterior plevis view,lateral and abduction view of bilateral hip were taken,CE angle（center-edge angle） and AC angle（acetabular roof obliquity） were measured,the changes of the rotational center of the hip ,Shenton＇s line and the degree of osteoarthritis were recorded ,the Harris score was obtained before and after operation.[Results]The femoral head coverage was improved in all patients. On average ,the CE angle was improved from 3.2 （-15°～15°）to 28.5°（20°～40°）,the AC angle was declined from 26.6°（15°～38°）to 3.9°（0°～12°）. The rotational center of the hip was medialized in 19 hips（63.3%）,the discontinuity rate of Shenton＇s line was declined from 67% to 23%. On average 4.2 years follow-up ,1 case lost follow-up,the degree of osteoarthritis in 28 hips was not aggravated,pain was aggravated in 1 hip ,the Harris score was improved from 82.7（67～96） to 97.8（87～100）.Two patients have had Fibre-union of pubic and one patient has had stress fracture of the inferior pubic ramus postoperatively,non-union of iliac and posterior column of the osteotomy or the greater trochanter was not found.[Conclusion]The method of modified rotational acetabular osteotomy for treatment of adult acetabular dysplasia is effective and safety.