Dega截骨术治疗学龄前儿童DDH的疗效分析

发布时间：2018-03-31 12:30

  本文选题：发育性髋关节脱位　切入点：Dega截骨术　出处：《山东大学》2017年硕士论文

【摘要】：研究背景:发育性髋关节脱位(Developmental Dislocation of Hip,DDH)是小儿骨科中的常见畸形,在我国平均发病率约3.9‰,南方发病率较北方为低,习惯背婴儿的民族发病率相对较低。该疾病的发生与分娩方式、生后抢救方法和襁褓措施密切相关。对于6个月以内的Ortolani征阳性婴儿,常以Pavlik吊带治疗。0.5～1.5岁或2岁的婴儿,可根据具体情况行髋关节闭合或切开复位+石膏外固定术治疗,必要时可术前牵引或辅助长收肌松解,石膏固定3个月后更换外展支具继续固定3个月。1.5～2岁以上的患儿,保守治疗效果较差,往往需要截骨手术干预。用于治疗学龄前(18个月～72个月)儿童DDH的髋臼成形术较多,其中以Pemberton术式和Dega术式最为常用,相关报道较多。但是所有这些报道都是针对某一术式的疗效分析,并未论及不同髋臼形态与术式选择和细节操作之间的关系,也即没有论述基于髋臼自身形态的、针对性的截骨术应用指征。同心圆复位是髋臼成形术的前提,但复位后应用成形术是为了塑造怎样的髋臼?这个问题至今无人回答。我们回顾性分析获得随访的接受Dega术式治疗的学龄前儿童DDH病例,尝试对以上2个问题进行回答。研究目的:分析Dega截骨术治疗学龄前(1.5～6岁)儿童DDH的疗效,总结髋臼成形术的个性化应用体会。研究内容:回顾性分析获得随访的行Dega术式治疗的学龄前DDH患儿28例共34髋,手术时年龄28± 10个月(18～72个月)。34髋均为完全脱位。根据术前X线片上假臼形态分为4组,A组3例3髋,曾行保守治疗,无明显假臼形成;B组7例7髋,未行保守治疗,无明显假臼形成;C组6例9髋,假臼明显,压迫侵蚀真臼;D组12例15髋,真假臼广泛融合(融合臼)。分析手术前后髋关节形态的变化、功能的改善。讨论股骨头缺血性坏死(AVN)的发生情况。研究结果:·术后随访67士 14个月(48～96个月),末次随访时患儿年龄95±15个月(73～126个月)。髋臼指数由45° ±6。(32～57°)改善至10° ±7。(-6～27°),Reimer 指数由 0.95±0.12(0.53～1)改善至0.15±0.11(-0.2～0.42),术后中心边缘角23° ±7°(11～43°),所有差异均有统计学意义(p0.01)。术前34髋Shenton线均不连续,随访时31髋恢复连续性,2髋仍中断,1髋反向不连续。根据改良Severin影像学分类,Ⅰ类20髋、Ⅱ类12髋、Ⅲ类2髋,优良率94%。根据KalamchiMacEwen股骨头缺血性坏死分型,Ⅱ型9髋,余25髋无坏死,坏死率26%。根据改良McKay临床功能分级,优29髋、良4髋、可1髋,优良率97%。综合A、C组病例行高水平Dega术式的5髋均未发生AVN,而行低水平Dega术式的7髋中5髋发生AVN,发生率71%(p=0.028)。综合B、D组病例行高水平Dega术式的3髋均发生AVN,而行低水平Dega术式的19髋中仅1髋发生AVN,发生率5%(p=0.003)。差异均有统计学意义(p0.05)。研究结论:Dega截骨术治疗学龄前儿童DDH疗效显著,值得临床推广应用。高水平Dega术式铰链位置高、截骨远端下压幅度小,适用于矫正保守治疗后的残留髋臼发育不良和假臼形成明显的病例;低水平Dega术式铰链位置低,下压幅度大,适用于真臼或融合臼的矫正。获取满意的覆盖并打造臼头匹配性包容是髋臼成形术的基本要求,个性化治疗DDH必须针对不同的髋臼形态选择相应术式;不同术式各有适用范围,不应混用。研究意义:本研究是针对不同的髋臼形态,而非针对脱位程度进行疗效评价,分析的是基于髋臼形态的手术疗效,因而对不同术式适应证之间相互联系和区别进行探索,是其意义所在。
[Abstract]:Background: the developmental dislocation of the hip (Developmental Dislocation of Hip, DDH) is common in pediatric department of orthopedics deformity, in our country the average incidence rate of about 3.9 per thousand, the incidence is relatively low in the south, the habit of carrying a baby's national incidence is relatively low. The occurrence and mode of delivery of the disease, after the rescue methods and measures are closely related. The baby within 6 months of the positive Ortolani sign baby, often Pavlik sling for the treatment of.0.5 ~ 1.5 or 2 year old baby, according to the specific circumstances of hip joint closed or open reduction and plaster external fixation, when necessary preoperative traction or assisted long adductor muscle relaxation, 3 months after the plaster fixation replacement abduction brace fixed to 3 months.1.5 to children over the age of 2, conservative treatment is poor, often need osteotomy for the treatment of preschool intervention. (18 ~ 72 months) children DDH acetabuloplasty more, The Pemberton operation and Dega operation is most commonly used, reported more. But all of these reports are the effectiveness of an operation, and the relationship between form and not different type selection and operation of acetabular details of the operation is not discussed based on their morphology for acetabular osteotomy, application of indications. Concentric reduction is a prerequisite for arthroplasty, but the reduction after the application of angioplasty is how to shape the acetabulum? This problem has no answer. We retrospectively analyzed and followed up by Dega treatment of preschool children DDH cases, try to answer the above 2 questions. The purpose of the study is to analysis Dega osteotomy for the treatment of preschool (1.5 ~ 6) effect in children with DDH, summarize the experience of the application of personalized acetabuloplasty. Research contents: a retrospective analysis was performed Dega surgical treatment and follow-up of preschool DDH patients 鍎，

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