股骨大转子长斜形截骨联合人工全髋关节置换术治疗成人高脱位DDH的疗效分析

The analysis of the effects of long oblique osteotomy of greater trochanter of femur combined with total hip arthroplasty for the treatment of adult developmental high dislocation of hip

目的探讨股骨大转子长斜形截骨在治疗成人高脱位发育性髋关节脱位(developmental dislocation of hip DDH)中的临床疗效。方法实验组:选取2012年2月至2015年2月本院收治的11例高脱位DDH患者的临床资料,11例患者均采用全髋人工关节假体置换联合股骨大转子长斜形截骨钢丝内固定术。其中,男3例,女8例。年龄45~72岁,平均56.5岁,术后末次随访髋关节功能按改良Merle d’Aubingne-Postel评分系统评估。对照组:通过医院病历管理平台获得自2009年1月至2012年1月本院采用全髋人工关节假体置换联合股骨大转子下横形截骨术治疗17例患者的临床资料,最后电话得到随访的有12例,获取病历数据得知12例患者的平均手术时间、出血量等相关数据。将实验组与对照组的数据进行对比分析。结果实验组11例患者均得到随访,随访时间12~18个月,平均15.8个月。平均手术时间(120.05±32.50) min,术中出血量(270.15±72.50) mL,末次随访髋关节功能按改良Merle d’Aubingne-Postel评分系统来评估:优7例,良3例,可1例,差0例,优良率90.91%。无1例发生坐骨神经损伤。对照组平均手术时间(160.08±95.50) min,术中出血量(380.02±75.70) mL,优良率91.67%。有1例坐骨神经损伤,末次随访时已恢复。两组病例治疗效果的优良率通过χ~2检验,P>0.05。手术时间及出血量通过t检验,p<0.05。结论采用股骨大转子长斜形截骨能够获得与转子下横形截骨相同的临床效果,但其手术时间、术中出血量明显减少,术中手术创伤减小、手术操作难度降低。

Objective To study the clinical effects of the method of long oblique osteotomy of greater trochanter of femur used in adult developmental high dislocation of hip.Methods The experimental group:there were 11 cases,which had the high dislocation of DDH,treated by total hip replacement arthroplasty and long oblique osteotomy of greater trochanter with internal fixation of steel wires from February 2012 to February 2015.There were 3 males and 8 females,aged from45 to 72 years,with an average age of 56.5 years.To evaluate the function of hip joint used the Point-Scoring system of improved Merle d’Aubingne-Postel at the last follow-up.The control group:through the medical records management platform in our hospital,there were clinical data of 17 cases with developmental high dislocation of hip which were allied total hip replacement arthroplasty with subtrochanteric cross shape osteotomy,from January 2009 to January 2012.There were only 12 cases that were follow-up visited through the way of telephone at last.The data of the experimental group and the control group were compared and analyzed.Results The 11 cases in the experimental group were followed-up for12 to 18 months,averaging 15.8 months.The average operation time was(120.05±32.50) min,the average amount of bleeding in operation was(270.15±72.50) mL.To evaluate the function of hip joint used the Point-Scoring system of improved Merle d’Aubingne-Postel at the last follow-up.The outcome was 7 excellent cases,3 good cases,1 fair case and 0 bad case.The excellent and good rate was 90.91%.No sciatic nerve injury occurred.In the control group,the average operation time was(160.08±95.50) min of the 12 cases,the average amount of bleeding in operation was(380.02±75.70) mL.The excellent and good rate was 91.67%.One case which had injured sciatic nerve has recovered at the last follow-up.Comparing the excellent and good rate of the two groups through Chi-square test,the outcome was P>0.05.Comparing the time of operation and amount of bleeding through t-test,the outcome was P<0.05.Conclusion The clinical effects of the long oblique osteotomy group are the same excellent as the subtrochanteric cross shape osteotomy group,but the time of operation and the amount of bleeding are obviously less than the control group and the operative difficulty index was absolutely reduced and the intraoperative trauma is also reduced.