应用改良Pemberton骨盆截骨术治疗6岁以上发育性髋关节发育不良患儿的中期随访结果

Mid-term follow-up results of modified Pemberton's pelvic osteotomy for developmental hip dislocations in children over 6 years old

目的探讨应用改良Pemberton骨盆截骨术治疗6岁以上发育性髋关节发育不良(DDH)患儿的中期疗效。方法对2001年1月至2017年12月内蒙古医科大学第二附属医院小儿骨科采用改良Pemberton骨盆截骨术联合或不联合股骨转子下旋转短缩截骨术一期手术治疗的DDH患儿60例(74髋)的临床资料进行回顾性分析。其中男22例,女38例;手术时年龄(8.20±2.56)(6~15)岁。左侧20例,右侧26例,双侧14例。术前Tonnis分级Ⅱ级38髋(51.35%),Ⅲ级10髋(13.51%),Ⅳ级26髋(35.14%)。联合应用股骨转子下旋转短缩截骨52例(61髋),未联合应用股骨转子下旋转短缩截骨8例(13髋)。初次治疗50例(64髋),残余畸形治疗10例(10髋)。依照年龄将全部患者分为6岁≤年龄<8岁组和年龄≥8岁组。采集术前Tonnis分级和髋臼指数(AI)以及末次随访AI、中心边缘角(CE)和股骨头缺血坏死(AVN)发生情况并进行比较;采用McKay临床评定标准和Severin影像学评定标准分别对术后患者髋关节功能和放射学结果进行评估。采用χ2检验,单因素筛选及多因素logistic回归模型对数据进行统计学分析。P<0.05为差异有统计学意义。结果全部患者均获得随访,随访时间为(5.86±3.63)(2~17)年。术前AI=(37.18±10.67)°;末次随访AI=(14.11±5.76)°,CEA=(38.59±11.46)°。术后Severin评价优良率为71.6%,McKay评价优良率为74.3%;AVN发生率为18.9%(12例,14髋)。2个年龄组患者McKay评分和Severin评分差异均无统计学意义(P=0.135,0.129)。是否出现AVN(均P<0.001)和术前Tonnis分级(P=0.002,<0.001)是影响术后McKay和Severin评分的主要因素。结论改良Pemberton骨盆截骨术是治疗6岁以上DDH患儿有效安全的手术方式;发生AVN和术前Tonnis分级较高是影响预后的独立危险因素。

Objective To investigate the effects of modified Pemberton's pelvic osteotomy on developmental dysplasia hip(DDH)in children over 6 years old.Methods Clinical data of 60 patients over 6 years of age with DDH(74 hips)underwent modified Pemberton pelvic osteotomy with or without proximal femoral osteotomy were retrospectively analyzed.There were 22 males(36.67%),38 females(63.33%),20 cases in left hip(27.0%),26 cases in right hip(35.1%)and 14 cases in bilateral hips(37.8%).The age at operation was(8.20±2.56)(6-15)years.The acetabular index(AI),preoperative Tonnis grading,central edge angle(CE)and the occurrence of avascular necrosis(AVN)of femoral head at the last follow-up were collected.Clinical function and radiological results were assessed according to McKay's and Severin's grading systems,respectively.All the patients were divided into 2 groups:<8 years old and≥8 years old.The data were analyzed by chi-square test,univariate screening and multivariate logistic regression model.Results The follow-up duration was(5.86±3.63)(2-17)years.The preoperative and final follow-up AI was(37.18±10.67)°and(14.11±5.76)°,respectively.The final follow-up CEA was(38.59±11.46)°.According to Severin's imaging evaluation criteria,the excellent and good rate was 71.6%.According to McKay's clinical evaluation criteria,the excellent and good rate was 74.3%.The incidence of AVN was 18.9%(12 cases,14 hips).There was no statistically significant differences in McKay's and Severin's scores between the 2 groups(P=0.135,0.129).Univariate and multivariate screening results showed that the presence of AVN(all P<0.001)and preoperative Tonnis grading(P=0.002,<0.001)were the main factors influencing postoperative McKay's and Severin's scores.Conclusion The modified Pemberton pelvic osteotomy is a effective and safe surgical method for DDH patients older than 6 years.Occurrence of AVN and higher preoperative Tonnis grading are independent risk factors for prognosis.