两种截骨术治疗儿童发育性髋关节脱位的疗效比较

Comparison effect of two kinds of ostetomies for treatment of developmental dislocation of the hip in children

目的比较骨盆髂骨截骨术(Salter截骨术)和关节囊周围髂骨截骨术(Pemberton截骨术)治疗儿童发育性髋关节脱位(DDH)的疗效。方法根据截骨方式不同将85例DDH患儿分为Salter组(45例)和Pemberton组(40例)。比较两组中心边缘角、骨性髋臼指数、Reimers指数、髋关节功能优良率、股骨头坏死率。结果患儿均获得随访,时间36~49个月。两组术后中心边缘角较术前增大,骨性髋臼指数、Reimers指数较术前减小,差异均有统计学意义(P<0.05);术后骨性髋臼指数Pemberton组低于Salter组(P<0.05);术后中心边缘角、Reimers指数两组比较差异均无统计学意义(P>0.05)。末次随访时髋关节功能优良率两组比较差异无统计学意义(P>0.05)。末次随访时股骨头坏死率Salter组低于Pemberton组(P<0.05)。结论Salter截骨术与Pemberton截骨术治疗儿童DDH均可取得良好疗效,Pemberton截骨术对骨性髋臼指数的改善更明显,而Salter截骨术的股骨头坏死率相对更低,两者各有其优、缺点,可根据患儿适应证选择截骨方式。

Objective To compare the efficacy of pelvic iliac osteotomy(Salter osteotomy)and pericapsular iliac osteotomy(Pemberton osteotomy)in the treatment of developmental dislocation of the hip(DDH)in children.Methods According to different osteotomy methods,85 children with DDH were divided into Salter group(45 cases)and Pemberton group(40 cases).The center edge angle,osteoacetabular index,Reimers index,the excellent-good rate of hip function and femoral head necrosis rate were compared between the two groups.Results All patients were followed up for 36~49 months.The center edge angle of the two groups were increased after surgery than the preoperation,while the osteoacetabular index and Reimers index were decreased after surgery,with statistical significance(P<0.05).The postoperative osteoacetabular index in Pemberton group was lower than that in Salter group(P<0.05).There were no statistical differences in center edge angle and Reimers index between the two groups(P>0.05).At the last follow-up,there was no statistical difference in the excellent-good rate of hip function between the two groups(P>0.05).The necrosis rate of femoral head in Salter group was lower than that in Pemberton group at the last follow-up(P<0.05).Conclusions Both Salter osteotomy and Pemberton osteotomy can achieve good efficacy in the treatment of DDH in children.Pemberton osteotomy has more obvious improvement in osteoacetabular index,while Salter osteotomy has relatively lower necrosis rate of femoral head.Both have advantages and disadvantages,and osteotomy can be selected according to the indications of children.