改良Salter骨盆截骨术治疗幼儿发育性髋关节脱位
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摘要
[目的]介绍改良Salter骨盆截骨术,随访其治疗幼儿发育性髋关节脱位的短期临床效果。[方法]回顾性分析2013年7月～2015年12月本院采用切开复位联合改良Salter骨盆截骨术治疗幼儿发育性髋关节脱位的病例资料,纳入患儿共30例(30髋),均为单侧髋关节全脱位,其中男2例,女28例,年龄13～24个月,平均(18.57±2.66)个月;左侧19髋,右侧11髋。记录手术时间、髋臼指数、临床功能恢复情况及再脱位、股骨头缺血性坏死等并发症情况。[结果]所有病例手术时间50～75 min,平均(60.23±8.76) min,无血管、神经损伤等严重术中并发症。术中失血约10～30 ml,平均(21.17±6.91) ml,均未输血。除1髋术后1 d再脱位,经更换石膏后复位良好外,其他患儿均达到同心复位。髋臼指数由术前(38.03±6.27)°减少至术后(28.49±5.63)°,平均矫正[(9.75±7.31)°,95%CI (7.11～12.28)°]。随访16～46个月,平均(28.33±7.57)个月,随访期间3髋(10.00%)发生I型股骨头缺血性坏死。末次随访时,按照改良Mckay临床功能评定标准,优26髋(86.67%),良4髋(13.33%),优良率100.00%。在影像方面,所有病例手术侧均无再脱位,均未发生髂骨翼畸形,手术侧髋臼指数随时间延长进一步改善,与非手术侧相等,甚至优于对侧,因为非手术侧有8髋髋臼发育不良。[结论]改良Salter骨盆截骨术微创优效,有助于加速髋关节脱位的髋臼重塑,减少残余髋臼发育不良的发生。
[Objective] To introduce a modified Salter pelvic osteotomy, and to explore the short-term clinical outcome for developmental dislocation of the hip(DDH). [Methods] A retrospective study was done on 30 children(30 hips) who underwent the modified Salter osteotomy for unilateral total hip dislocation due to DDH from July 2013 to December 2015. The patients, including 2 boys and 28 girls, aged from 13 to 24 months with an average of(18.57±2.66) months, involving 19 left hips and 11 right hips. The operation time, functional recovery and radiographic assessment, such as reduction quality, redislocation, acetabular index and femoral head necrosis, were evaluated. [Results] The children had operation performed for 50 to 75 mins with a mean of(60.23±8.76) mins, with no serious complications, such as neurovascular injuries, in any of them. The intraoperative blood loss ranged from 10 to 30 ml approximately with an average of(21.17±6.91) ml, and no blood transfusion needed in anyone of the children. Except one child who got redislocation at 1 day postoperatively, which regained concentric reduction by plaster cast changed, all the children achieved concentric reduction of the affected hips. Correspondingly, the acetabular index significantly decreased from(38.03±6.27)° preoperatively to(28.49±5.63)° postoperatively(P<0.05), associated with a corrective decrement of [(9.75±7.31)°, 95%CI(7.11～12.28)°]. All the children were followed up for 16 to 46 months with an average of(28.33±7.57) months. During the follow-up, 3 hips(10.00%) were proved type I femoral head necrosis. At the latest follow (86.67%) and good in 4 hips(13.33%) based on Mckay criteria, associated with excellent and good rate of 100.00%. In term of radiographic assessment, no redislocation and no iliac deformity were observed on the operated side in any of children, whereas the acetabular indexes of operated sides significantly improved over time to be equal, even superior to the unoperated sides due to 8 unoperated hips with acetabular dysplasia. [Conclusion] This modified Salter osteotomy is minimally invasive, and facilitates acetabular remodeling, and then decrease residual acetabular dysplasia.
[Objective] To introduce a modified Salter pelvic osteotomy, and to explore the short-term clinical outcome for developmental dislocation of the hip(DDH). [Methods] A retrospective study was done on 30 children(30 hips) who underwent the modified Salter osteotomy for unilateral total hip dislocation due to DDH from July 2013 to December 2015. The patients, including 2 boys and 28 girls, aged from 13 to 24 months with an average of(18.57±2.66) months, involving 19 left hips and 11 right hips. The operation time, functional recovery and radiographic assessment, such as reduction quality, redislocation, acetabular index and femoral head necrosis, were evaluated. [Results] The children had operation performed for 50 to 75 mins with a mean of(60.23±8.76) mins, with no serious complications, such as neurovascular injuries, in any of them. The intraoperative blood loss ranged from 10 to 30 ml approximately with an average of(21.17±6.91) ml, and no blood transfusion needed in anyone of the children. Except one child who got redislocation at 1 day postoperatively, which regained concentric reduction by plaster cast changed, all the children achieved concentric reduction of the affected hips. Correspondingly, the acetabular index significantly decreased from(38.03±6.27)° preoperatively to(28.49±5.63)° postoperatively(P<0.05), associated with a corrective decrement of [(9.75±7.31)°, 95%CI(7.11～12.28)°]. All the children were followed up for 16 to 46 months with an average of(28.33±7.57) months. During the follow-up, 3 hips(10.00%) were proved type I femoral head necrosis. At the latest follow (86.67%) and good in 4 hips(13.33%) based on Mckay criteria, associated with excellent and good rate of 100.00%. In term of radiographic assessment, no redislocation and no iliac deformity were observed on the operated side in any of children, whereas the acetabular indexes of operated sides significantly improved over time to be equal, even superior to the unoperated sides due to 8 unoperated hips with acetabular dysplasia. [Conclusion] This modified Salter osteotomy is minimally invasive, and facilitates acetabular remodeling, and then decrease residual acetabular dysplasia.
引文
[1]杨建平.切开复位、Salter骨盆截骨、股骨近端短缩旋转截骨术治疗发育性髋关节脱位[J].中华骨科杂志,2010,30(12)1252-1258.
[2]边臻,朱振华,郭源,等.Salter截骨术与Pemberton截骨术治疗2~3岁发育性髋关节脱位的疗效分析[J].中华骨科杂志2015,35(9):935-941.
[3]Kalamchi A.Modified salter osteotomy[J].J Bone Joint Surg Am1982,64-A(2):183-187.
[4]Yoon TR,Rowe SM,Chung JY,et al.A new innominate Osteotomy in Perthes disease[J].J Pediatr Orthop,2003,23(2):363-367.
[5]熊斌,易申德,吴欣乐,等.同种异体骨块在Salter截骨术中应用[J].临床小儿外科杂志,2005,4(3):229.
[6]Handelsman JE,Weinberg J.Iliac apophyseal displacement:an alternative in pediatric pelvic osteotomies[J].J Pediatr Orthop B,2008,17(2):69-72.
[7]张中礼,杨建平,龚仁钰,等.切开复位骨盆Salter截骨术治疗发育性髋关节脱位的长期随访研究[J].中华骨科杂志,2014,34(12):1183-1189.
[8]李天友,刘振兴,马勇,等.Bernese骨盆三联截骨术治疗大龄DDH与DDH残留畸形[J].中华小儿外科杂志,2013,34(4):286-289.
[9]Rebello G,Zilkens C,Dudda M,et al.Triple pelvic osteotomy in complex hip dysplasia seen in neuromuscular and teratologic conditions[J].J Pediatr Orthop,2009,29(6):527-534.
[10]Wenger DR.Surgical treatment of developmental dysplasia of the hip[J].Instr Course Lectures,2014,63(3):313-323.
[11]沙佳,严亚波,徐会法,等.不同年龄组大龄发育性髋关节脱位患儿手术疗效的临床研究[J].中国矫形外科杂志,2017,25(19):775-780.
[12]蔡海清,王志刚,冯林,等.Salter骨盆截骨术治疗学步期发育性髋关节脱位[J].中华小儿外科杂志,2007,28(6):314-317.
[13]Kothari A,Grammatopoulos G,Hopewell S,et al.How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia[J].Clin Orthop,2016,474(5):1199-1208.
[14]Chen Q,Deng Y,Fang B.Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6years old.A retrospective study[J].Acta Orthop Belg,2015,81(3):375-383.
[15]刘振江,马瑞雪,吉士俊.Salter骨盆截骨术后髋关节形态学发育变化的研究[J].中华小儿外科杂志,2004,25(1):47-50.
[16]Arslan H,Sucu E,Ozkul E,et al.Should routine pelvic osteotomy be added to the treatment of DDH after 18 months[J].Acta Orthop Belg,2014,80(2):205-210.
[17]Malvitz T,Weinstein S.Closed reduction for congenital dysplasia of the hip.Functional and radiographic results after an average of thirty years[J].J Bone Joint Surg Am,1994,76:1777-1792.
[18]Lindstrom J,Ponseti I,Wenger D.Acetabular development after reduction in congenital dislocation of the hip[J].J Bone Joint Surg Am,1979,61(1):112-118.2018-08-30
[2]边臻,朱振华,郭源,等.Salter截骨术与Pemberton截骨术治疗2~3岁发育性髋关节脱位的疗效分析[J].中华骨科杂志2015,35(9):935-941.
[3]Kalamchi A.Modified salter osteotomy[J].J Bone Joint Surg Am1982,64-A(2):183-187.
[4]Yoon TR,Rowe SM,Chung JY,et al.A new innominate Osteotomy in Perthes disease[J].J Pediatr Orthop,2003,23(2):363-367.
[5]熊斌,易申德,吴欣乐,等.同种异体骨块在Salter截骨术中应用[J].临床小儿外科杂志,2005,4(3):229.
[6]Handelsman JE,Weinberg J.Iliac apophyseal displacement:an alternative in pediatric pelvic osteotomies[J].J Pediatr Orthop B,2008,17(2):69-72.
[7]张中礼,杨建平,龚仁钰,等.切开复位骨盆Salter截骨术治疗发育性髋关节脱位的长期随访研究[J].中华骨科杂志,2014,34(12):1183-1189.
[8]李天友,刘振兴,马勇,等.Bernese骨盆三联截骨术治疗大龄DDH与DDH残留畸形[J].中华小儿外科杂志,2013,34(4):286-289.
[9]Rebello G,Zilkens C,Dudda M,et al.Triple pelvic osteotomy in complex hip dysplasia seen in neuromuscular and teratologic conditions[J].J Pediatr Orthop,2009,29(6):527-534.
[10]Wenger DR.Surgical treatment of developmental dysplasia of the hip[J].Instr Course Lectures,2014,63(3):313-323.
[11]沙佳,严亚波,徐会法,等.不同年龄组大龄发育性髋关节脱位患儿手术疗效的临床研究[J].中国矫形外科杂志,2017,25(19):775-780.
[12]蔡海清,王志刚,冯林,等.Salter骨盆截骨术治疗学步期发育性髋关节脱位[J].中华小儿外科杂志,2007,28(6):314-317.
[13]Kothari A,Grammatopoulos G,Hopewell S,et al.How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia[J].Clin Orthop,2016,474(5):1199-1208.
[14]Chen Q,Deng Y,Fang B.Outcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6years old.A retrospective study[J].Acta Orthop Belg,2015,81(3):375-383.
[15]刘振江,马瑞雪,吉士俊.Salter骨盆截骨术后髋关节形态学发育变化的研究[J].中华小儿外科杂志,2004,25(1):47-50.
[16]Arslan H,Sucu E,Ozkul E,et al.Should routine pelvic osteotomy be added to the treatment of DDH after 18 months[J].Acta Orthop Belg,2014,80(2):205-210.
[17]Malvitz T,Weinstein S.Closed reduction for congenital dysplasia of the hip.Functional and radiographic results after an average of thirty years[J].J Bone Joint Surg Am,1994,76:1777-1792.
[18]Lindstrom J,Ponseti I,Wenger D.Acetabular development after reduction in congenital dislocation of the hip[J].J Bone Joint Surg Am,1979,61(1):112-118.2018-08-30