Salter骨盆截骨术治疗髋关节发育不良的中期随访

Evaluation of mid-term follow-up after Salter innominate osteotomy in developmental dysplasia of the hip

目的 通过对Salter骨盆截骨术治疗髋关节发育不良术后影像学的测量评估,揭示其术后髋臼形态塑形发育规律,并探讨手术疗效与手术年龄及影像学指标间的关系.方法 回顾性分析1990年1月至2004年12月因髋关节发育不良在我科接受Salter骨盆截骨术治疗的患儿的基本资料.随访时间≥3年且具有完整手术前、后影像学资料的患髋共61髋.选取术前、术后6周取克氏针后、术后1年、术后2～3年及末次随访时的骨盆正位片.测量髋臼指数（AI）、Sharp髋臼角（SAA）和中心边缘角（CEA）,并对末次随访作Severin评级.结果 术后6周时AI平均改善了14°,术后2～3年为髋臼重塑的高峰时期,末次随访SAA平均为41°,基本已达正常水平.术后6周时CEA平均为23°,术后2～3年增加至25°,末次随访为26°.末次随访Severin评级总体优良率（Ⅰ、Ⅱ级）84%,中差（Ⅲ、Ⅳ、Ⅴ、Ⅵ级）16%.年龄越大,优良率越低,但6岁之后仍能获得70%的优良率.术后6周取克氏针时,Severin评级优良患儿和中差患儿改善的AI差异无统计学意义（P＞0.05）;术后2～3年,优良患儿有明显改善,而中差患儿呈恶化趋势,差异有统计学意义（P＜0.05）;至末次随访时,优良患儿与中差患儿Sharp角和中心边缘角差异非常显著（P＜0.05）.结论 Salter骨盆截骨术治疗髋关节发育不良主要改变异常的髋臼开口方向,使股骨头和髋臼同心复位,髋臼获得重塑能力.术后2～3年是髋臼形态重塑最快速的时期,此时各项影像学指标一般逐渐下降至接近正常.若此时各项指标无明显改善或呈变差趋势,中远期疗效不佳.

Objectives To evaluate the mid-term outcoming after Salter innominate osteotomy in developmental dysplasia of the hip （DDH） ,and to observe the developmental characteristics of the hip after operation and the relationships between the mid-term outcome and radiographic parameters as well as age at operation. Methods Forty-four patients with 61 treated hips were selected. The patients were treated with Salter innominate osteotomy and followed-up for at least three years with intact serial radiographs. Radiographs taken before operation, 6 weeks, 1 year and 2-3 years after operation and in the latest follow-up were selected. Acetabular index （ AI） , Sharp acetabular angle （SAA） and center-edge angle of Wiberg （CEA） were measured and Severin classification was done according to radiographs taken in the latest follow-up. Results The average correction of AI was 14° postoperatively. The acetabulum remodels best at 2-3 years after operation when the average AI became very close to normal. In the latest follow-up the SAA was 41° which could be regarded as normal. Postoperative CEA was on average 23° which increased to 25° 2-3 years later. In the latest follow-up, the average CEA was 26° . The ratio of excellent and good outcomings （ Severin Ⅰ ,Ⅱ） was 84% , while the ratio of moderate and poor outcomings （ Severin Ⅲ , Ⅳ , Ⅴ , Ⅵ） was 16%. Age at operation had a negative effect on outcomings. Although 70% patients operated after age 6 had satisfactory outcomings. The Severin Ⅰ ,Ⅱ group showed no difference in AI from Ⅲ , Ⅳ, Ⅴ ,Ⅵ group 6 weeks after operation, but the AI of the former obviously improved 2-3 years after operation while that of the latter deteriorated. Significant difference in SAA and the CEA could be observed in the latest follow-up. Conclusions Salter innominate osteotomy focuses on normalizing the abnormal acetabular direction in DDH children as well as stimulating the remodeling of the acetabulum, which provides a satisfactory middle-term outcoming. The acetabulum remodels rapidly during the first three years after operation when AI and CEA develops into normal. Interference should be adopted if these changes have not appeared in the first three years.