DDH股骨近端截骨儿童髋部锁定板与普通锁定板固定的比较

Locking compression pediatric hip plate versus conventional locking compression plate in proximal femoral osteotomy for treatment of developmental dysplasia of hip

[目的]对比分析儿童髋部锁定加压接骨板(locking compression pediatric hip plate,LCP-PHP)与普通锁定加压钢板(locking compression plate,LCP)联合Salter截骨术治疗儿童发育性髋关节脱位(developmental dysplasia of the hip,DDH)的临床疗效。[方法]回顾性分析本院2013年12月~2015年12月收治的46例60髋DDH患儿。所有患者均按照Salter截骨术联合股骨近端截骨术治疗,根据股骨截骨内置物的不同,22例29髋使用LCP-PHP钢板固定(儿童板组),24例31髋使用普通LCP钢板固定(普通板组)。临床随访采用Mckay标准对髋关节功能评分,X线随访采用Severin标准。[结果]患者均顺利完成手术,术后随访12~36个月,平均(19.0±7.2)个月。两组术前股骨颈干角、前倾角、髋臼指数、中心边缘角差异无统计学意义(P>0.05),两组术后及末次随访时股骨颈干角、前倾角、髋臼指数、中心边缘角均较术前有明显改善,差异有统计学意义(P<0.01)。两组间比较儿童板组术后及末次随访时股骨颈干角、前倾角改善更明显,与普通板组间差异有统计学意义(P<0.01)。根据Severin标准:儿童板组优良率(96.56%),普通板组优良率(93.55%),两组优良率比较差异无统计学意义(x2=0.000,P=1.000);根据Mckay标准:儿童板组优良率(96.56%),普通板组优良率(74.19%),两组优良率比较差异有统计学意义(x2=4.252,P=0.039)。[结论]LCP-PHP钢板治疗儿童DDH比普通LCP钢板矫形效果好,具有符合解剖及生物力学特点、角度稳定性强、对骨膜及血供损伤小、并发症少、截骨愈合快可早期功能锻炼的优点。

[Objective] To compare clinical outcome of locking compression pediatric hip plate （LCP-PHP） versus conventional locking compression plate （LCP） in proximal femoral osteotomy for treatment of developmental dysplasia of hip （DDH）. [Methods] A retrospective study was conducted on 46 children with DDH （60 hips） who were treated in our hospital from De- cember 2013 to December 2015. All the children underwent Salter pelvic osteotomy combine with the proximal femoral osteoto- my. In term of implant used for femoral osteotomy, 22 children （29 hips） had osteotomy fixed with LCP-PHP, while 24 children （31 hips） with LCP. Clinical outcome was compared using Mckay criterion for hip function and Severin scale on X ray. [Re- suits] All the patients were operated smoothly, followed up from 12 to 36 mouths with an average of （19.0＋7.2） months. There was no significant difference between the two groups in preoperative femoral neck angle, anteversion angle, acetabular index, and central edge angle （P〉0.05）. The aforesaid parameters were significantly improved postoperatively and at the latest follow up in both group compared with those before operation. The LCP-PHP group got more remarkable improvement in femoral neck angle and anteversion angle than the LCP group （P〈 0.01）. According to Severin radiographic criterion, the excellent and good rate was 96.56% in LCP-PHP group, whereas 93.55% in the LCP group, without significant difference between the two groups （P〉0.05）. However, the excellent and good rate in term of Mckay criterion of the hip function proved 96.56% versus 74.19%, the LCP-PHP was statistically superior to the LCP（x2=4.252, P=0.039）. [Conclusion] With advantages of contour consistent to local anatomy and improved biomechanical design for enhanced angle stability, the LCP-PHP is superior to the LCP in proximal femoral osteotomy for treatment of DDH.