髋关节发育不良的实用分型与术式选择

The Classification and Selection of Surgical Procedures in Coxa Dysplasia

目的 :探讨既能反映髋关节发育不良的病理形态 ,又有助于术式选择的临床实用性形态分型法。方法 :分别测量髋关节发育不良 70例 134髋的X线片中CE角、AHI、AC角、Sharp角、HX、HY、ATD等 7项指标 ,以发育不良的圆弧形头臼关节面平行与否为依据 ,分同心圆和非同心圆型。同心圆型再分为轻型 (CE角 >10°或AHI≥ 75 % ) :中型(CE角 <10° >0°或AHI <75 % >6 5 % ) ;重型 (CE角≤ 0°或AHI≤ 6 5 % ) 3个亚型 ,非同心圆型以不同肢位关节面对应关系的改善度 ,再分内翻、外翻和不定型 3个亚型。结合 46髋手术资料 ,提出分型与术式选择的方法。结果 :134髋中同心圆型占 76 .7% ,非同心圆型的不定型占 7.8%。同心圆型最适宜髋臼旋转截骨类术式 ,其中轻型也是造盖术的良好适应证。非同心圆型适合Chiari截骨术 ,其中内外翻型更适宜髋臼旋转和转子间联合截骨术式 ,不定型则适合姑息性或关节置换术。结论 :实用分型法既能客观反映病理形态 ,又能结合不同术式特点和力学因素选择术式 。

Objective: To explore the practical classification of correct reflection pathological forms and for contribute surgical procedure in dysplasia of hip joint.Methods:To measure CE.Sharp,AHI,AC,HX,HY,ATD and so on X-ray index for 134 hip of coxa dysplasia.Subject to yes and no the circular are parallel to joint surface,divide to concentric circles (CC)type and non concentric circles (NCC)type.The CC type subdivide lighter (CE angle>10°or AHI≥75%)and medium(CE angle<10°>0°or AHI<75%>65%)and heavy(CE angle≤0°or AHI≤65%)hypotypes.The NCC subdivide varus and valgus and indefinite hypotypes.According to this classification performed different surgical procedure for 46 hip joints of coxa dysplasia.Result:The CC types to take possession of 76.7%,most adapt to periacetabular rotational osteotomy.The varus and valgus type of the NCC adapt to associated procedures of periacetabular and intertrochanteric osteotomy,indefinite type to take of 7.8%,adapt to perform Chiari osteotomy or THR.Conclusion:The classifications is a practically and quantificatiomal,contribute to selection of surgical procedures correctly.