股骨头骨骺阻滞术早期干预痉挛性脑瘫髋关节发育不良的疗效分析

Efficacies of capital femoral epiphysiodesis in early intervention for hip dysplasia of spastic cerebral palsy

目的探讨痉挛性脑瘫髋关节发育不良患儿早期行股骨头骨骺阻滞术干预的临床疗效。方法收集2014年6月至2016年10月由扬州大学医学院附属扬州市妇幼保健院收治的痉挛性脑瘫髋关节发育不良患儿作为研究对象,采用股骨头骨骺阻滞术干预治疗者为观察组,同期未进行手术干预者为对照组,分别于干预前、干预后6个月、干预后1年应用股骨头外移百分比(migration percentage,MP值)及颈干角(neck-shaft angle,NSA)评估疗效。结果本研究共纳入37例(59髋)痉挛性脑瘫髋关节发育不良患儿,其中观察组9例(12髋),对照组28例(47髋),两组患儿基本情况无统计学差异(P> 0. 05),说明两组具有可比性。干预前两组患儿MP值比较差异无统计学意义(P> 0. 05),干预后6个月及1年观察组MP值低于对照组,差异有统计学意义(P <0. 05)。观察组干预后6个月及1年MP值与干预前相比差异有统计学意义(P <0. 05)。对照组干预后6个月及1年MP值与干预前相比差异均无统计学意义(P> 0. 05)。干预前两组NSA比较差异无统计学意义(P> 0. 05),干预后6个月及1年观察组NSA均低于对照组,差异有统计学意义(P <0. 05)。观察组与对照组干预后6个月及1年与干预前相比NSA均降低,差异有统计学意义(P <0. 05)。结论股骨头骨骺阻滞术操作简单,创伤小,并发症少,能有效改善股骨头外移程度,降低髋关节脱位风险,具有临床推广价值。

Objective To explore the clinical efficacies of capital femoral epiphysiodesis in early intervention for hip dysplasia of spastic cerebral palsy. Methods A total of 37 children with 59 hips dysplasia of spastic cerebral palsy treated between June 2014 to September 2016 were recruited.The observation group underwent capital femoral epiphysiodesis while those without surgical intervention were selected as control group.The efficacies were evaluated by migrarion percentage (MP) and neck-shaft angle (NSA) before intervention,half a year and one year after intervention. Results Nine cases with 12 hips belonged to observation group while 28 cases with 47 hips control group.No statistically significant inter-group differences existed in general profiles (P>0.05).There were no inter-group statistical differences in MP value before intervention (P>0.05 ).The differences of MP value were statistically significant between observation and control groups at half a year or one year after intervention (P<0.05).After one year or half a year,MP value decreased than before intervention and the difference was statistically significant (P<0.05).No significant difference existed in MP value of control group at half a year and one year after intervention (P>0.05).There were no statistical inter-group differences of NSA value before intervention (P>0.05).The NSA values of observation group half one year or one year after intervention decreased than those in control group.And the difference was statistically significant (P<0.05).The NSA values of two groups half one year or one year after intervention were lower than those before intervention.And there were significant differences (P<0.05). Conclusion Capital femoral epiphysiodesis is mini-invasive and efficacious for hip dysplasia of spastic cerebral palsy early.It is simple in handling and there are fewer complications.It can effectively decrease the degree of lateral dislocation of femoral head and reduce the risk of hip dislocation.The method was worthy of wider clinical applications.