经髋臼顶及耻骨上、下支骨盆三处截骨矫正髋臼发育不良的应用解剖

The Application of Anatomy of Acetabular Roof, Pubic Upper and Lower Ramus Osteotomy for Ace- tabular Dysplasia

目的：探讨经髋臼顶、耻骨上、下支骨盆三处截骨术矫正髋臼发育不良的耻骨上支截骨角度和耻骨下支截骨长度，为临床截骨矫形，达到理想股骨头覆盖提供解剖学依据。方法：选取15具成人湿性骨盆标本（30侧髋关节），随机分成A组、B组，每组15侧髋关节；再将其随机分为3个亚组，每组5侧髋关节。将髋臼CE角打磨成0。，制作髋臼发育不良模型，再按Salter截骨将髂骨截断。A、B两组分别在耻骨上支中点由内上向外下与矢状面成30。和45。截断，各亚组依次将耻骨下支在耻骨联合以远分别截去1．0cm、1．5cm、2．0cm骨块。截骨后将髋臼向前外及下方旋转，并用克氏针固定髂骨截骨端。测量A、B各亚组耻骨上支断端的接触面积，摄x线片，测量各亚组的cE角、Sharp角、臼头指数等几项数据。所得数据用SPSS13．0软件进行统计学处理。结果：A组各亚组耻骨上支的接触面积均小于B组，差异有统计学意义（P〈0．01），A、B组内3个亚组间的cE角、Sharp角以及臼头指数值比较差异有统计学意义（P〈0．01）；A、B两组间的各亚组的cE角、Sharp角以及AHI值比较差异无统计学意义（P〉0．05）。结论：经髋臼顶及耻骨上、下支骨盆三处截骨术中，在耻骨上支中点由内上向外下与矢状面成45。截骨条件下，耻骨下支截除2．0cm骨块，能够达到最佳的耻骨上支断端接触面积和实现股骨头满意覆盖的CE角、Sharp角及臼头指数值。

[ Abstract ] Objective：To introduce the acetabular roof, pubic upper and lower ramus rotation osteotomy used to treat the developmental dysplasia of the hip. The experiment explores the optimal osteotomy angle and length in order to provide the anatomical basis for the clinical precision osteotomy and the best coverage of the femoral head. Methods：There were 30 adult hip joints. The hip joints were randomly divided into two groups, 15 hip joints in each group. Each group was randomly divided into three subgroups, 5 cases in each subgroup. Then we manufactured acetabular dysplasia model. All of the acetabula were polished to make the CE angle to 0 ~. Iliums were truncated in according to Salter osteotomy. In group A and B , superior ramus of pubis were truncated at the midpoint from medial - superior to lateral - inferior respectively with 30~and 45~ sagittal. The inferior ramus of pubis in each subgroup was respectively truncated at 1.0 cm ,1.5 cm,2.0 em bone. Then the acetabula were rotated laterally and inferiorly and fixed by Kirschner wires. Of A and B subgroup, the contact area of the superior ramus of pubis were measured. Femoral head coverage, CE angle and Sharp angle were measured in each group . SPSSI 3.0 was used to analyze the data. Results：The contact area of superior ramus of pubis of group A and B had statistically significant difference（ P 〈 0. O1 ）. In each subgroup of group A and B, CE angle, Sharp angle, and AHI were significantly different（P 〈 0.01 ）. No significant differences were CE angle, Sharp angle, and Femoral head average of group A and group B （ P 〉 0.05 ）. Conclusions ： The results suggest that superior ramus of pubis are truncated at the midpoint from medial - superior to lateral - inferior with 45°sagittal angle, and the inferior ramus of pubis truncated at 2.0 cm bone can achieve the best contact area of superior ramus of pubis and achieve best femoral head coverage, CE angle, Sharp angle and Femoral head coy-erase.