髋臼发育不良不同入路方式髋臼周围截骨术对创伤应激、下肢力线及预后的影响

Effects of periacetabular osteotomy with different approaches on traumatic stress,lower limb strength and prognosis of acetabular dysplasia

目的探究髋臼发育不良(DDH)不同入路方式髋臼周围截骨术(PAO)对创伤应激、下肢力线及预后的影响。方法2021年1月~2022年1月我院收治DDH病人97例,随机分为两组。对照组48例,行常规髂腹股沟入路PAO治疗,研究组49例,行改良髂腹股沟入路PAO治疗。比较两组手术及术后康复指标、Mckay临床疗效、下肢力线、并发症、手术前后创伤应激因子[肾上腺素(NE)、皮质醇(COR)、血管紧张素Ⅱ(AngⅡ)]、髋关节影像学指标[前侧CE角(ACEA)、外侧CE角(LCEA)、髋臼指数(AI)]、改良Harris髋关节功能评分(mHHS)、髋关节结果评分日常生活能力量表(HOS-ADL)。结果研究组与对照组手术时间分别为(128.64±18.73)分钟和(141.80±21.59)分钟,术中出血量分别为(472.95±35.18)ml和(495.68±40.26)ml,术后引流量分别为(242.39±32.74)ml和(305.81±39.56)ml,住院时间分别为(11.57±2.29)天和(12.86±2.41)天,两组比较差异均有统计学意义(P<0.05);研究组Mckay临床疗效优良率(95.92%)高于对照组(81.25%),差异有统计学意义(P<0.05);研究组与对照组术后1天、3天、7天血清NE分别为(73.16±8.07)ng/L和(81.33±8.52)ng/L,(65.81±7.29)ng/L和(72.24±7.65)ng/L,(45.98±6.31)ng/L和(50.37±7.02)ng/L;COR分别为(164.84±19.35)ng/L和(178.62±21.46)ng/L,(142.69±17.81)ng/L和(157.36±19.22)ng/L,(88.79±16.13)ng/L和(97.62±17.50)ng/L;AngⅡ分别为(138.74±20.51)mmol/L和(150.19±21.36)mmol/L,(128.35±17.69)mmol/L和(137.18±19.24)mmol/L,(119.82±17.41)mmol/L和(128.73±18.50)mmol/L。两组比较差异均有统计学意义(P<0.05)。研究组与对照组术后3个月、6个月、12个月ACEA分别为(29.71±4.81)°和(27.68±4.53)°,(29.80±4.75)°和(27.72±4.60)°,(29.64±4.79)°和(27.63±4.51)°,LCEA分别为(33.79±6.12)°和(31.04±5.83)°,(33.82±6.10)°和(31.10±5.90)°,(33.75±6.08)°和(31.05±5.77)°,AI分别为(6.15±1.86)°和(7.03±1.94)°,(6.08±1.82)°和(7.01±1.89)°,(6.12±1.84)°和(7.06±1.90)°,mHHS评分分别为(72.15±7.65)分和(68.23±7.71)分,(76.51±7.52)分和(72.19±7.94)分,(90.13±5.16)分和(86.76±5.72)分,HOS-ADL评分分别为(79.92±7.50)分和(76.26±7.62)分,(80.85±7.42)分和(77.13±7.66)分,(89.73±6.37)分和(86.25±7.15)分,两组比较差异均有统计学意义(P<0.05);两组下肢力线与并发症比较,差异无统计学意义(P>0.05)。结论改良髂腹股沟入路PAO治疗DDH可优化手术,减轻机体创伤应激因子,能进一步提升疗效,改善股骨头覆盖状态及髋关节功能,提高生活质量,且安全性较高。

Objective To investigate the effects of different approaches of periacetabular osteotomy(PAO)on traumatic stress,lower limb strength and prognosis of acetabular dysplasia(DDH).Methods Ninety-seven patients with DDH in our hospital from January 2021 to January 2022 were randomly divided into two groups.Among them,48 patients in the control group received conventional ilioinguinal approach PAO treatment,while 49 patients in the study group received modified ilioinguinal approach PAO treatment.The surgical and postoperative rehabilitation indexes,Mckay clinical efficacy,lower limb line of force,complications,traumatic stress factors before and after surgery[adrenalin(NE),cortisol(COR),angiotensinⅡ(AngⅡ)],hip imaging indexes[anterior CE Angle(ACEA),lateral CE Angle(LCEA),acetabular index(AI)]and changes were compared between the two groups Good Harris hip function Score(mHHS),hip outcome score Daily Living Ability Scale(HOS-ADL).Results The operation time of the study group and the control group were(128.64±18.73)min and(141.80±21.59)min respectively,the intraoperative blood loss were(472.95±35.18)ml and(495.68±40.26)ml respectively,the postoperative drainage were(242.39±32.74)ml and(305.81±39.56)ml respectively,and the hospital stay were(11.57±2.29)D and(12.86±2.41)d respectively,with significant differences between the two groups(P<0.05);The excellent and good rate of McKay's clinical efficacy in the study group(95.92%)was higher than that in the control group(81.25%),and the differences were statistically significant(P<0.05);Serum NE in the study group and control group at 1 d,3 d,and 7 d postoperatively were(73.16±8.07)ng/L and(81.33±8.52)ng/L,(65.81±7.29)ng/L and(72.24±7.65)ng/L,(45.98±6.31)ng/L and(50.37±7.02)ng/L,respectively,and COR were(164.84±19.35)ng/L and(178.62±21.46)ng/L,(142.69±17.81)ng/L and(157.36±19.22)ng/L,(88.79±16.13)ng/L and(97.62±17.50)ng/L,respectively,and AngII was(138.74±20.51)mmol/L and(150.19±21.36)mmol/L,(128.35±17.69)mmol/L and(137.18±19.24)mmol/L,and(119.82±17.41)mmol/L and(128.73±18.50)mmol/L,respectively,and the differences between the two groups were all statistically significance(P<0.05);ACEA at 3,6,and 12 months postoperatively in the study and control groups were(29.71±4.81)°and(27.68±4.53)°,(29.80±4.75)°and(27.72±4.60)°,(29.64±4.79)°and(27.63±4.51)°,respectively,and LCEA was(33.79±6.12)°and(31.04±5.83)°,(33.82±6.10)°and(31.10±5.90)°,(33.75±6.08)°and(31.05±5.77)°,and AI was(6.15±1.86)°and(7.03±1.94)°,(6.08±1.82)°and(7.01±1.89)°,(6.12±1.84)°and(7.06±1.90)°,respectively.mHHS scores was(72.15±7.65)and(68.23±7.71),(76.51±7.52)and(72.19±7.94),(90.13±5.16)and(86.76±5.72),and HOS-ADL scores were(79.92±7.50)and(76.26±7.62)points,(80.85±7.42)and(77.13±7.66)points,(89.73±6.37)and(86.25±7.15)points,and the differences between the two groups were statistically significant(P<0.05);the comparison of lower limb force lines and complications between the two groups showed no statistically significant differences(P>0.05).Conclusion Modified ilioinguinal approach PAO in the treatment of DDH can optimize the operation,reduce traumatic stress factors,further improve the curative effect,improve the status of femoral head coverage and hip function,and improve the quality of life,with high safety.