髋脱位莎氏术后影像学与功能评价的相关性

Correlation between radiological manifestations and functional outcomes of hips after surgery for developmental dislocation of the hip in children

目的通过评价儿童髋关节脱位莎氏手术复位后影像学改变与临床功能评价的相关性，探索髋关节发育不良术后后遗发育不良的表现和关节功能之间的联系，对患儿日常生活的影响，以及什么样的髋关节后遗表现才需要进一步治疗的问题。方法收集1994年1月至2000年12月间，因髋关节脱位在我院行开放复位，改良Zahradnicek手术，并接受随访的17例患儿，共26个髋关节，其中双侧髋关节病例9例，右侧髋关节病例4例，左侧髋关节病例4例。随访时间为12-20年，平均为15．6年。拍摄骨盆X线正位片，记录和评估Sharp角，外侧CE角，Shenton线连续性，髋臼深度和骨关节炎。按Harris评分评估记录患儿关节功能。采用Spearman检验评估髋关节残余发育不良畸形与骨关节炎之间的关系；采用Spearman检验评估髋关节残余发育不良畸形与临床功能Harris评分之间的关系；采用Spearman检验评估骨关节炎与临床功能Harris评分之间的关系。结果髋关节残余发育不良畸形与骨关节炎之间无相关性（R=0．3600，P=0．1558）；髋关节残余发育不良畸形与临床功能Harris评分之间无相关性（R=-0．0665，P=0．7999）；骨关节炎与临床功能Harris评分之间有相关性（R=-0．6121，P=0．0090）。结论髋关节脱位复位术后中期随访结果，髋关节残余发育不良的严重程度并不决定关节功能的好坏，这一时期功能差的关节一般是其他原因导致的。但如影像学伴有骨关节炎表现时，关节功能是受影响的。医生除需要根据影像学改变决定治疗方案外，还需考虑对患儿的综合评估。

Objective To explore the relationship between residual dysplasia of hip and functional outcomes after surgery for developmental dislocation of hip in children. Methods From January 1994 to December 2000, 17 children （26 hips） were diagnosed as developmental dislocation of the hip and underwent modified Zahradnicek procedure at our hospital. The involved hip joints were bilateral （n= 9）, right-sided （n = 4） and left-sided （n = 4）. The average follow-up period was 15.6 （12-20） years. The values of Sharp angle, acetabular depth and center-edge angle were measured while the integrity of Shenton line and radiological manifestations of osteoarthritis were assessed by pelvic radiograph. The functional outcomes of hip were assessed by the Harris questionnaire. The relationships between residual dysplasia of hip joint deformity and osteoarthritis, residual dysplasia of hip joint deformity and Harris score and osteoarthritis and Harris score were assessed by Spearman＇s test respectively. Results No correlation existed between residual dysplasia of hip joint deformity and osteoarthritis （R= 0. 360 0, P = 0. 155 8） or Harris score （R = - 0. 066 5, P = 0. 799 9）. However, there was correlation between osteoarthritis and Harris score （ R = - 0. 612 1, P = 0. 009 0 ）. Conclusions Based on the results of mid-term follow-ups, severity of hip residual dysplasia is not a decisive factor for its function. Some other causes may contribute to poor function of involved hip. If osteoarthritis is detected on pelvic radiograph, joint function shall be affected. Proper treatment is selected according to radiological findings and comprehensive evaluations.