低龄儿童髋关节发育不良 Salter 截骨术后影像学评估

Imaging evaluations of Salter innominate osteotomy for developmental dysplasia of the hip

目的：探讨低龄儿童发育性髋关节脱位（ DDH）接受Salter截骨术后的影像学评估效果。方法南方医院创伤骨科2011年3月至2012年8月收治的DDH接受Salter骨盆截骨术治疗的患儿51例，70髋，年龄18～72月龄。患儿于术前和术后第2天摄骨盆正位X线片并影像学测量髋臼指数（ AI）、髋臼倾斜角（ SA）、闭孔角、闭孔高度；并分别于术后3、6、12个月再次摄X线片。术后还测量沈通线、髂骨远端截骨端外移距离比、远端截骨端下压角度。采用配对t检验对手术前后影像学数据进行统计学分析。结果患儿术前AI为35.5°±2.3°，术后为14.6°±1.6°（ P＝0.000）；患儿术前SA为50.6°±3.7°，术后为33.1°±3.2°（P＝0.000）；术前闭孔角为58.3°±3.9°，术后为39.5°±2.8°；术前闭孔高度平均为（1.65±0.26）cm，术后为（1.10±0.14）cm，均改善明显（均P＝0.000）；且随访术后3、6、12个月以上评估指标均有继续下降趋势。术后髂骨远端截骨端外移指数平均为30.1％±3.6％，远端截骨端下压角度平均为31.3°±4.1°。术后有6髋沈通线连续性欠佳，占总数8.57％。结论低龄儿童行Salter截骨术后髋臼及骨盆各影像学评估指标均得到显著改善，且1年内有继续改善趋势；通过对截骨处影像指标的测量为衡量手术的标准提供了数据参考。

Objective To evaluate the imaging efficacies after Salter innominate osteotomy for developmental dysplasia of the hip （ DDH）.Methods A total of 51 DDH patients with 70 hips were recruited between March 2011 to August 2012.All of them underwent Salter innominate osteotomy.Preoperative radiographs including acetabular index （ AI） , sharp angle （ SA） , obturator angle and obturator height were measured.And postoperative radiographs were taken at 2 days, 3 months, 6 months and 1 year to measure the parameters of AI , sharp acetabular angle , obturator angle , obturator height , shifting index and descending angle of distal iliac end.Paired t test was used for statistical analyses.Results The average correction of AI was 35.5°±2.3°preoperatively versus 14.6°±1.6°postoperatively （P=0.000）.The average correction of Sharp angle was 50.6°±3.7°preoperatively versus 33.1°±3.2°postoperatively （P=0.000）.The average correction of obturator angle was 58.3°±3.9°preoperatively versus 39.5°±2.8° postoperatively（P=0.000）.The average correction of obturator height was （1.65 ±0.26）cm preoperatively versus（1.10 ±0.14） cm postoperatively （ P=0.000）.At 3 months, 6 months and 1 year post-operation, the average values of AI , SA, obturator angle and obturator height continued to fall.Both of them showed statistical improvement.Shifting index and descending angle of distal iliac end were 30.1%±3.6% and 31.3°±4.1°on average.Six （8.57%） Shenton lines were bad.Conclusions The imaging evaluations of acetabulum and pelvis show marked improvements until 1 year in DDH patients after Salter innominate osteotomy.It provides data reference for operative evaluations through measuring the imaging parameters of truncation bone.