Dega截骨术治疗儿童发育性髋关节发育不良的临床初步研究

发布时间：2018-03-23 19:27

本文选题：Dega骨盆截骨术　切入点：发育性髋关节发育不良　出处：《中国人民解放军医学院》2016年博士论文

【摘要】：背景及目的：越来越多的证据表明Dega截骨术因其截骨铰链可变,可改善发育性髋关节发育不良(DDH)患儿髋臼各方向的覆盖不良,在儿童DDH的治疗中,受到越来越多的关注。本研究的目的是,报告我科应用Dega截骨术治疗1.5-14岁DDH患者,应用高位Dega截骨术治疗6岁以下DDH患者及低位Dega截骨术治疗6岁及6岁以上DDH患者的初步结果,评估其临床及影像学结果。对象及方法：回顾性分析2001年12月到2004年12月期间，应用Dega截骨术治疗的1.5岁以上、14岁以下的DDH患者30例(34个髋);2005年3月到2012年12月期间，应用高位Dega截骨术治疗的1.5岁以上、6岁以下的DDH患者162例(191个髋)：及2005年3月到2012年12月期间,应用低位Dega截骨术治疗的6岁以上、14岁以下的DDH患者42例(57个髋)。总结其一般资料、临床表现、影像学特点及预后。临床评价主要采用改良McKay's临床评价标准：影像学评价主要包括：Severin影像学评价标准,平均髋臼指数(AI),Sharp角及CE角。结果：(一)Dega截骨术所治疗的1.5-14岁DDH患者,经过平均7.7年(5.0-12.0年)的随访,根据改良McKay's临床评价标准及Severin影像学评价标准，最新随访的临床及影像学结果优良率分别为85.3%和88.2%。平均AI由术前38.5°降为最新随访的20.1°,平均Sharp角由术前50.1°降为最新随访的37.5°,平均CE角由术前-10.10升高到最新随访的30.2°。(二)高位Dega截骨术治疗1.5-6岁的DDH患者,经过平均8.7年(2.0-16.9年)的随访,根据改良McKay's临床评价标准及Severin影像学评价标准，最新随访的临床及影像学结果优良率分别为92.7%和91.1%。平均AI由术前38.0°降为最新随访的20.8°,平均Sharp角由术前59.9°降为最新随访的39.2°,平均CE角由术前-10.70升高到最新随访的29.4°。(三)低位Dega截骨治疗6-14岁的大龄DDH患者,经过平均7.2年(2.0-12.0年)的随访,根据改良McKay's临床评价标准及Severin影像学评价标准,最新随访的临床及影像学结果优良率分别为92.9%和91.2%。术后即刻影像学指标逐渐趋于正常,并在随访过程中,逐渐正常。平均AI由术前31.9°降为最新随访的20.2。，平均Sharp角由术前59.3°降为最新随访的38.8°,平均CE角由术前-10.9°升高到最新随访的35.2°。结论：Dega骨盆截骨术及高、低位Dega截骨术操作简便、安全,疗效可靠,可显著改善学步期后不同年龄段DDH儿童的临床及影像学结果,可作为较好的选择在学步期后年龄段DDH患儿的治疗中应用。
[Abstract]:Background and objective: there is more and more evidence that Dega osteotomy can improve acetabular coverage in all directions in children with developmental hip dysplasia due to its variable osteotomy hinges, which is used in the treatment of DDH in children. The purpose of this study was to report that Dega osteotomy was used to treat 1.5-14 year old DDH patients. The primary results of high Dega osteotomy for patients under 6 years of age with DDH and low Dega osteotomy for patients aged 6 years and over 6 years old were used to evaluate the clinical and imaging results. Objects and methods: a retrospective analysis was made between December 2001 and December 2004. Dega osteotomy was performed in 30 patients (34 hips) with DDH over 1.5 years of age and under 14 years of age. High Dega osteotomy was performed in 162 patients with DDH over 1.5 years of age and under 6 years of age (191 hips: from March 2005 to December 2012). 42 cases (57 hips) of DDH over 6 years old and under 14 years old were treated with low Dega osteotomy. Imaging features and prognosis. Modified McKay's criteria were used for clinical evaluation. The imaging evaluation included: 1: Severin imaging evaluation standard, average acetabular index (AI) sharp angle and CE angle. Results: 1.5-14 years old DDH patients treated with 1. 1% Dega osteotomy. After an average of 7.7 years (5.0-12.0 years), according to the modified McKay's clinical evaluation criteria and Severin imaging evaluation criteria, The average AI decreased from 38.5 掳to 20.1 掳, the mean Sharp angle decreased from 50.1 掳to 37.5 掳, and the average CE angle increased from -10.10 掳to 30.2 掳. 2) High Dega osteotomy for the treatment of DDH patients aged 1.5 to 6 years, After an average of 8.7 years (2.0-16.9 years), according to the modified McKay's clinical evaluation criteria and Severin imaging evaluation criteria, The average AI decreased from 38.0 掳to 20.8 掳, the mean Sharp angle decreased from 59.9 掳to 39.2 掳, and the mean CE angle increased from -10.70 to 29.4 掳. 3) low Dega osteotomy for the treatment of older DDH patients aged 6-14 years, According to the modified McKay's clinical evaluation standard and the Severin imaging evaluation standard, the excellent and good rates of the latest follow-up were 92.9% and 91.2%, respectively. The average AI decreased from 31.9 掳to 20.2.The mean Sharp angle decreased from 59.3 掳to 38.8 掳, and the average CE angle increased from -10.9 掳to 35.2 掳. Low Dega osteotomy is simple, safe and reliable. It can significantly improve the clinical and imaging results of DDH children of different ages after toddler. It can be used as a better choice in the treatment of DDH children of post-toddler age.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R726.8

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