股骨近端截骨对2~3岁TonnisⅡ型发育性髋关节发育不良患者治疗效果的研究

Efficacy of femoral osteotomy for children aged 2-3 years with Tonnis Grade Ⅱ developmental dysplasia of the hip.

目的比较分析股骨近端短缩截骨与不截骨对2~3岁TonnisⅡ型发育性髋关节发育不良(developmental dysplasia of the hip,DDH)患者手术后疗效的影响,探讨该类型DDH患者的最佳治疗策略。方法回顾性分析2016年1月至2017年12月南京医科大学附属儿童医院收治的48例2~3岁TonnisⅡ型DDH(48髋)患者的临床资料,其中男4例,女44例,年龄24~34个月,平均年龄28.6个月。根据股骨近端截骨与否分为股骨不截骨组(n=21)和股骨截骨组(n=27)。采用Mckay标准评估术后髋关节功能,Severin标准评估影像学评分,评估股骨头缺血性坏死(avascular necrosis,AVN)发生率及髋关节再脱位率,根据以上指标比较两组患者的治疗效果。结果48例患者的平均随访时间22.1个月(17~27个月)。股骨不截骨组有2例(2/21,9.5%)发生AVN,股骨截骨组有3例(3/27,11.1%)发生AVN,差异无统计学意义(χ^2=0.032,P=0.858)。股骨不截骨组Mckay评分19例为优,2例为良;股骨截骨组Mckay评分23例为优,4例为良;差异无统计学意义(χ^2=0.302,P=0.582)。股骨不截骨组Severin评分优17例,良4例;股骨截骨组Severin评分优20例,良7例;差异无统计学意义(χ^2=0.316,P=0.574)。两组均无一例发生髋关节再脱位。结论对于2~3岁TonnisⅡ型DDH患者行切开复位手术时不推荐常规应用股骨短缩截骨术。

Objective To compare the clinical outcomes after open reduction with and without femoral shortening for children aged 2 to 3 years with Tonnis gradeⅡdevelopmental dysplasia of the hip(DDH).Methods From January 2016 to December 2017,48 children aged 2 to 3 years with Tonnis gradeⅡDDH(48 hips)were retrospectively reviewed.There were 21 hips in femoral non-shortening group and 27 hips in femoral shortening group.The average age was 28.6(25-34)months.The Severin criteria were used for evaluating the imaging scores.And avascular necrosis(AVN)and redislocation rate were employed for judging the therapeutic outcomes.Results The mean follow-up period was 22.1(17-27)months.Femoral non-shortening group:2 AVN cases(2/21,9.5%),the outcomes were excellent(n=19)and decent(n=2)using the modified McKay criteria,excellent(n=17)and decent(n=4)using the Severin scale,no redislocation;femoral shortening group:3 AVN cases(3/27,11.1%),excellent(n=23)and decent(n=4)using the modified McKay criteria,excellent(n=20)and decent(n=7)using the Severin scale and no redislocation.No statistically significant differences existed in modified McKay criteria,Severin score or AVN rate.Conclusion Femoral shortening is not recommended for children aged 2-3 years with Tonnis gradeⅡDDH.