经前外侧入路髋臼周围三联截骨术在儿童髋关节疾病中的应用

Triple periacetabular osteotomy through anteriolaterior approach for hip disturbance in children.

目的探讨前外侧入路、单一切口内进行髋臼周围三联截骨，在青少年髋臼发育不良、髋关节半脱位、股骨头无菌性坏死、发育性髋脱位治疗后残余覆盖不良等髋关节疾病治疗中的应用。方法选择19例（22髋）患儿，平均手术年龄9岁2个月（6～12岁）。术中将Bikini切口向下部分延伸，在单一切口内，进行髋臼周围三联截骨（髂骨、耻骨上支及坐骨支截骨）。术中通过C型臂透视定位，辅助确定截骨位置及截骨方向，使髋臼围绕股骨头骺向前、外侧旋转并向内移，在没有增加股骨头压力的前提下，达到良好的头臼覆盖；使用多枚克氏针或螺钉经髂骨截骨面支撑固定，术后用髋人字石膏固定6周。结果通过比较，手术前后及随访期间X线片上的髋臼指数（或Sharp角）、中心边缘角（CEA）、髋臼与股骨头覆盖率均有明显改善。少数患儿出现坐骨支截骨不愈合，但不影响负重行走。结论采用前外侧入路、髋臼周围三联截骨，相对于其它髋臼周围三联截骨方式（如Tsnnis、Steel、LeCoeur等），具有经单一切口操作、髋臼旋转充分、截骨后内固定方便等特点，适合于Y型软骨尚未闭合，并需大角度改善头臼包容情况的患儿。

Objective The anterolateral, within a single incision Triple Acetabular Osteotomies, in the treatment of adolescent acetabular dysplasia, LCPD, DDH. Introduces the operation operating method, and surgical indications. Methods 19 patients, and 22 hips,average age 9 years and two months. In a single incision,in order to press around acetabular osteotomies. Through the C arm, auxiliary sure cut bone position and direction of bone cutting, make acetabular forward the lateral femoral head around, and to move in rotation, no increase in femoral head pressure; The use of Kirschner or screws osteotomies for the fixed. Result- s Through the comparison before surgery and during follow-up on the X-ray acetabular index （or Sharp An- gle） ,the center of edge Angle （ CEA）, acetabular femoral head cover rate, will be improved obviously. Con- clusion The triple osteotomies relative to other methods （such as Tonnis, Steel, LeCoeur, etc. ） with a single surgical incision,simple operation, the risk is small, rotating acetabular fully, can make the femoral head for good coverage. Suitable for Y cartilage has not been closed, and need to improve the acetabular inclusive teen- age patients.