髋臼旋转截骨术治疗髋臼发育不良

Rotational acetabular osteotomy for acetabular dysplasia

目的探讨髋臼旋转截骨术治疗髋臼发育不良的疗效。方法应用髋臼旋转截骨术治疗髋臼发育不良16例（18髋）,截骨线距臼周缘2 cm,做穹隆状截骨,凿断后再用弧度骨凿将髋臼向前外下方旋转。髋臼矫正到较正常位置后,截骨间隙呈楔形状,用类似间隙大小的楔形同种异体骨块嵌入,并用可注射状人工骨填满间隙,最后用2枚可吸收螺钉固定。测定并比较术前和术后JOA评分、CE角和Sharp角。结果16例均获随访,时间442个月。术后摄片髋关节复位位置好,股骨头及髋臼形状基本正常。髋臼旋转截骨及植入骨块2个月后骨性愈合,6个月后髋关节功能恢复正常17髋,较差1髋,无患髋的骨性关节炎病变继续恶化。JOA评分：术前为75.2分±3.1分,术后为93.5分±3.5分;CE角：术前为15.8°±1.3°,术后为33.4°±1.7°;Sharp角：术前为47.3°±2.5°,术后为29.8°±2.1°。JOA评分术后增加18.3分;CE角增加17.6°,Sharp角减少17.5°,差异有统计学意义（P〈0.05）。结论髋臼旋转截骨术可矫正头臼间异常的匹配关系,使疼痛得到缓解,并使骨性关节炎的过程得到有效遏制,是治疗髋臼发育不良合并早、中期骨性关节炎的理想术式。

Objective To introduce the method and effect of the treatment of acetabulum dysplasia by rotation acetabulum osteotomy.Methods 18 hips with acetabulum dysplasia were treated by rotation acetabulum osteotomy with measurement of JOA scoring preoperatively and postoperatively,CE angle and Sharp angle.Osteotomy were performed archedly 2.0 cm from acetabulum brim,the acetabulum was rotated anteriorly,laterally and inferiorly,the allograft bone and osteolet were inserted into the gap,and fixed by absorbable screws.Results The average follow-up time were 442 months.X-ray showed the relationship and shape of acetabulum and femoral head were restored to normal.Bone graft healed up within 2 months.The function of 17 hips were restored normal within 6 months.The JOA,CE and Sharp angles were restored from 75.2±3.1,15.8°±1.3° and 47.3°±2.5° preoperatively to 93.5±3.5,33.4°±1.7° and 29.8°±2.1° postoperatively.The JOA scores increased 18.3,CE angle increased 17.6°,and the Sharp angle decreased 17.5°.The difference was significant（P〈0.05）.Conclusions Rotation acetabulum osteotomy can correct the abnormal relation between femoral head and acetabulum,relieve the pain and effectively arrest the progression of osteoarthritis.It is an ideal method to treat the acetabulum dysplasia combined with osteoarthritis in early and medium stage.