单纯Pemberton髋臼成形术与联合股骨粗隆下旋转缩短截骨术治疗发育性髋关节脱位

Simple Pemberton's ilium osteotomy and combined unter-trochanter derotation-varisation osteotomy for developmental dysplasia of the hip:a case-control study

目的:回顾性比较单纯Pemberton髋臼成形术与联合股骨粗隆下旋转缩短截骨手术治疗发育性髋关节脱位的临床疗效。方法:2004年1月至2009年1月,对采用单纯Pemberton髋臼成形术或Pemberton髋臼成形术联合股骨粗隆下旋转缩短截骨手术治疗且获随访的141例发育性髋关节脱位患者的资料进行回顾性分析,其中57例采用单纯Pemberton髋臼成形术治疗(单纯髋臼成形手术组),男12例,女45例,年龄3～8岁;84例采用Pemberton髋臼成形术联合股骨粗隆下旋转缩短截骨手术治疗(联合手术组),男15例,女69例,年龄4～9岁。比较2组术后并发症及术后2年进行Severin放射学评价,并采用Mckay临床评定标准评价2组疗效。结果:单纯髋臼成形手术组患者随访30～52个月,平均38个月;联合手术组患者随访32～51个月,平均37个月。单纯髋臼成形手术组7例再脱位,4例股骨头坏死,5例关节僵硬;联合手术组无再脱位、股骨头坏死、患肢缩短,2例关节僵硬。术后2年McKay临床疗效评定结果:单纯髋臼成形手术组优27髋,良18髋,可12髋;联合手术组优52髋,良25髋,可7髋。联合手术组疗效优于单纯髋臼成形手术组。Severin X线评定标准结果:单纯髋臼成形手术组优27髋,良15髋,可15髋;联合手术组中优53髋,良22髋,可9髋。联合手术组优于单纯髋臼成形手术组。结论:与单纯髋臼成形手术相比,联合手术治疗发育性髋关节脱位在术后减少严重并发症及功能恢复方面有明显优势。联合手术组患者对术后综合结果更为满意。

Objective：To retrospectively compare the therapeutic effects of simple Pemberton＇s ilium osteotomy and combined unter-trochanter derotation-varisation osteotomy for developmental dysplasia of the hip（DDH）.Methods：Clinical data of 141 DDH patients who received either simple Pemberton＇s ilium osteotomy（n=57;12 male and 45 female;age range 3-8 years） or combined unter-trochanter derotation-varisation osteotomy（n=84;15 male and 69 female;age range 4-9 years） from January 2004 to January 2009 were collected.Postoperative complications,Severin＇s radiological outcomes and therapeutic outcomes as evaluated by Mcay criteria were compared between the two groups 2 years after operation.Results：The patients in simple Pemberton group were followed-up for 30-52 months（mean 38 months） and the patients in the combination group were followed-up for 32-51 months（mean 37 months）.There were 7 cases of dislocation,4 cases of avescular necrosis of femoral head and 5 cases of joint stiffness in simple Pemberton group vs 0 case of dislocation,contraction of the limb and ANFH,2 cases of joint stiffness in the combination group.Two years after surgery,the result as evaluated by McKay criteria was excellent in 27 cases,good in 18 cases and fair in 12 cases in simple Pemberton group vs 52,25 and 7 cases in the combination group.The overall clinical outcome in the combination group was better than that in simple Pemberton group.Severin X-ray evaluation showed excellent in 27 cases,good in 15 cases and fair in 15 cases in simple Pemberton group vs 53,22 and 9 cases in the combination group,indicating that the overall result in the combination group was better than that in simple Pemberton group.Conclusion：The overall clinical outcome of the combination group is better than that of simple Pemberton group in the treatment of pediatric DDH,especially in reducing postoperative complications and functional recovery.The patients in the combination group reported a higher postoperative satisfaction as compared with those in simple Pemberton group.