髋臼周围截骨术治疗中青年髋关节发育不良

Bernese periacetabular osteotomy through a modified Smith-Peterson approach for development dysplasia of the hip in young and middle-aged adult

[目的]探讨采用改良Smith-Peterson入路髋臼周围截骨术治疗中青年髋关节发育不良的手术适应证及临床疗效。[方法]回顾性分析2010年5月～2015年2月采用改良S-P入路髋臼周围截骨术治疗32例髋关节发育不良患者,男3例,女29例,年龄18～55岁,平均38.5岁。均为单侧手术,左侧19例,右侧13例,均无既往手术史。髋关节骨关节炎分期:T?nnis 0期23例,I期9例。1例Shenton线不连续。[结果]32例患者均顺利接受手术,无严重并发症。患者均获得14～82个月,平均38个月的随访。Harris评分由术前(69.80±6.70)分增加至末次随访时(89.37±3.93)分,两时间点间差异有统计学意义(P<0.05)。与术前相比,末次随访时LCE角[(9.50±3.66)°vs(32.51±3.13)°]和ACE角[(5.70±4.80)°vs(31.51±3.68)°]均显著增加,差异有统计学意义(P<0.05);而末次随访时髋臼顶倾斜角[(15.30±2.91)°vs(5.69±2.34)°]和股骨头超出指数[(28.50±3.87)%vs(10.20±5.10)%]均显著减少,差异有统计学意义(P<0.05)。32例患者中,1例由术前T?nnis I期改善为0期,其余分期无明显变化。术后仍有1例Shenton线不连续。[结论]只要严格掌握手术指征,术中精确操作,采用改良Smith-Peterson入路髋臼周围截骨治疗中青年髋关节发育不良可取得较好的临床疗效。

[Objective] To investigate the indications and clinical outcome of periacetabular osteotomy through a modified Smith-Peterson approach for development dysplasia of the hip（DDH）in young and middle-aged adult.[Methods]A retrospective study was conducted on 32 patients who had undergone Bernese periacetabular osteotomy through the modified Smith-Peterson approach for DDH from May 2010 to February 2015.Of them,3 males and 29 females aged from 18 to 55 years with an average of 38.5 years.All the patients were unilaterally affected,including 19 left sides and 13 right sides involved,without history of previous surgery.According to the Toennis classification,23 hips were classified as Grade 0,while the remaining 9 ranked as GradeⅠ.The Shenton line was discontinuous in 1 hip.[Results]All the patients had operation performed smoothly without serious complication in anyone of them.The patients were followed up for 14 to 82 months,with an average of 38 months.The Harris scores statistically increased from（69.80±6.70）preoperatively to（89.37±3.93）at the latest follow up（P〈0.05）.Compared preoperative data with those at the latest follow up,the lateral center-edge（LCE）angle[（9.50±3.66）°vs（32.51±3.13）°],and the anterior center-edge（ACE）angle[（5.70±4.80）°vs（31.51±3.68）°]were significantly enhanced（P〈0.05）,whereas the acetabular index[（15.30±2.91）°vs（5.69±2.34）°]and femoral head extrusion index[（28.50±3.87）%vs（10.20±5.10）%]considerably decreased（P〈0.05）.In term of the T？nnis grading for osteoarthritis,1 patient downgraded from Grade 1 to Grade 0,while the remaining 31 patients stayed unchanged.However,1 hip still had discontinuous Shenton line.[Conclusion]As long as selecting correct indication and handling skillful operation,the periacetabular osteotomy through the modified Smith-Peterson approach does achieve satisfactory results for DDH in the young and middle-aged.