大转子移位术矫正儿童及青少年短髋畸形

Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents

目的探讨大转子移位术矫正儿童及青少年短髋畸形的疗效。方法2005年8月至2011年1月，应用大转子移位术矫正儿童及青少年短髋畸形20例22髋，其中18例20髋获得随访。男4例，女14例；年龄7．5～15．0岁，平均11．4岁。5例6髋为Perthes病残留畸形，13例14髋为发育性髋脱位手术后股骨头坏死。4例4髋曾行大转子阻滞术。均行大转子移位术，矫正畸形后以拉力螺钉固定，术后石膏裤固定6周。结果随访14-79个月，平均31个月。术前有行走后疲劳不适感或髋关节疼痛18例，末次随访时消失或改善13例；术前16例存在跛行、Trendelenburg征阳性，末次随访时改善9例；术前12例13髋存在髋外展受限，术后明显改善，末次随访时髋关节外展范围（45．38°±1．05°）与术前（25．38°±1．20°）比较差异有统计学意义。大转子尖到股骨头上缘关节面水平的距离[（17．47±3．14）mm]、大转子尖到股骨头中心距离与股骨头半径之比（2．10±0．21）与术前[分别为（-2．89±4．62）mm、1．59±0．22]比较差异均有统计学意义；下肢长度差（0．78±0．26）cm，与术前[（0．83±0．33）cm]比较差异无统计学意义。结论对儿童及青少年短髋畸形，大转子移位术可以改善临床症状，恢复股骨近端正常解剖关系，重建髋关节生物力学环境，但不能改善下肢不等长。

Objective To evaluate the effect of greater trochanteric transfer for the treatment of coxa brevis in children and adolescents. Methods From August 2005 to January 2011, twenty patients （22 hips） with coxa brevis underwent greater trochanteric transfer. Among them 18 patients （20 hips） were available for evaluation, including 4 boys and 14 girls, with an average age of 11.4 years （range, 7.5-15.0 years） at operation. Five cases （6 hips） were caused by Perthes disease, and 13 cases （14 hips） were caused by developmental dysplasia of hip. Four patients （4 hips） had undergone greater trochanteric epiphyseodesis ever before. All patients were fixed with tension screw after the deformity was corrected during the operation. After operation, the human plaster spica was used for 6 weeks in all patients. Results All patients were followed up for 14 to 79 months （average, 31 months）. At the last follow-up, fatigue or pain in the hips disappeared or improved in 13 patients. Sixteen patients had limping and positive Trendelenburg sign preoperatively, at the last follow-up 9 patients got improvement. Twelve patients （13 hips） had limitation of abduction of the hip, the average range of abduction was 25.38°±1.20°, which was improved to 45.38°±1.05° at the last follow-up. The average articulotrochanteric distance and ratio of the distance from the greater troehanter tip to femoral head center and the radius of the femoral head at the last follow-up was （17.47±3.14） mm and 2.10±0.21, respectively, there were statistical differences compared with those before operation [（-2.89±4.62） mm and 1.59°0.22, respectiovely]. The average leg-length discrepancy at the last follow-up was （0.78±0.26） cm, which had on statistical differences compared with that [（0.83 ±0.33） cm] before operation. Conclusion Greater trochanteric transfer for the treatment of coxa brevis in children and adolescents could improve the clinical symptom, recover the normal anatomy of the proximal femoral, restore the hip biomechanics environment, but could not improve the leg-length discrepancy.