早期切开复位、Salter截骨术治疗发育性髋脱位合并股骨头坏死的长期随访

发布时间：2018-08-18 20:39

【摘要】：目的：通过回顾性分析切开复位、Salter骨盆截骨术治疗发育性髋脱位患儿的长期随访结果,探讨Salter骨盆截骨术后并发股骨头坏死的相关因素及股骨头坏死的远期影响。资料与方法：自1992年至2001年,共64例(82髋)患儿于我科行一侧或双侧切开复位、骨盆截骨术治疗发育性髋脱位,其中7例双髋脱位的患儿一侧行切开复位、Chiari骨盆截骨术或Dega髋臼成形术矫正畸形,此7髋排除在本研究之外。总共64例(75髋)行切开复位、Salter骨盆截骨术来矫正畸形,其中术前曾行保守治疗者5例(7髋)及神经肌肉型发育性髋脱位者2例(2髋)排除在本研究之外。符合纳入标准的57例(66髋)患儿中7例(8髋)随访失败,50例(58髋)获得随访,但在随访过程中有6例(7髋)因行二期行翻修手术排除在本研究之外,最终44例(51髋)纳入本研究并进行了评估,所有患儿末次随访时骨骼发育均已成熟。根据患儿末次随访影像学表现将其分为两组,一组为无股骨头坏死组,一组为有股骨头坏死组。分析两组病例术前因素(包括患儿性别、侧别、单双侧、Tonnis脱位程度及手术时年龄)、手术操作因素(包括术后沈通氏线是否连续、截骨端后侧皮质是否张开及手术前后髋臼指数差值)之间的差异,判断术前因素、手术操作因素与术后并发股骨头坏死之间的相关性；同时分析了有无股骨头坏死与末次随访时患儿影像学指标测量结果(包括CE角、Sharp角、股骨颈干角、Reimers指数)及髋关节Severin分型结果和Mckay功能分级结果的相关性。结果：末次随访时患儿平均年龄为15岁1个月(13岁1个月-22岁4个月),随访时间平均12年3个月(10年3个月-19年4个月)。无股骨头坏死组30例32髋,男6例7髋,女24例25髋,左侧18髋,右侧14髋,单侧19髋,双侧11髋,手术时平均年龄29.2个月；有股骨头坏死组19例19髋,男3例3髋,女16例16髋,左侧11髋,右侧8髋,单侧11髋,双侧8髋,手术时平均年龄28.4个月。对术前因素及手术操作因素单独进行统计学分析(卡方检验或T检验),结果显示术前因素和手术操作因素与术后并发股骨头坏死之间无明显相关性。再对术前因素及手术操作因素进行综合考虑,行Logistic多元素回归分析结果显示只考虑术前因素对术后股骨头坏死并发症发生的影响时,在0.05水平各因素与股骨头坏死发生无明显相关性；只考虑手术操作因素对术后股骨头坏死并发症发生的影响时,在0.05水平各因素与股骨头坏死发生无明显相关性；综合考虑术前与手术操作因素对术后股骨头坏死并发症发生的影响时,在0.05水平术前因素与股骨头坏死发生无明显相关性,但手术操作因素中手术前后髋臼指数差值与股骨头坏死发生有显著相关性,手术前后髋臼指数差值越大,术后并发股骨头坏死风险越大。对末次随访时对两组病例的影像学指标测量结果CE角、Sharp角、股骨颈干角及Reimers指数进行统计学分析(卡方检验或T检验),差异均无统计学意义。但两组病例髋关节Severin分型结果和Mckay功能分级结果之间差异有显著的统计学意义,不存在股骨头坏死的髋关节在Severin分型结果和Mckay功能分级结果中更容易被分类为优良,存在股骨头坏死的髋关节更容易被分类为中差。结论：切开复位、Salter骨盆截骨术治疗发育性髋脱位后并发股骨头坏死与术前患儿性别、侧别、单双侧、脱位程度及手术时年龄无明显相关性；和手术前后髋臼指数差值有一定相关性,差值越大,发生股骨头坏死风险越大,提示股骨头坏死可能与过度包容导致的股骨头压力过大有关。此外,存在股骨头坏死的患儿髋关节远期Severin分型结果和Mckay功能分级结果较不存在股骨头坏死的患儿差。
[Abstract]:Objective: To analyze the long-term follow-up results of open reduction and Salter pelvic osteotomy in the treatment of developmental dislocation of the hip (DDH), and to explore the related factors and long-term effects of femoral head necrosis after Salter pelvic osteotomy.
Materials and Methods: From 1992 to 2001, 64 children (82 hips) underwent unilateral or bilateral open reduction and pelvic osteotomy for developmental dislocation of the hip. Seven of them underwent unilateral open reduction and Chiari pelvic osteotomy or Dega acetabular plasty for correction of deformities. Sixty-four (75 hips) were excluded from this study. Open reduction and Salter pelvic osteotomy were performed to correct the deformity. Five conservative cases (7 hips) and two cases (2 hips) of neuromuscular developmental dislocation of the hip were excluded from the study. Of the 57 children (66 hips) who met the inclusion criteria, 7 (8 hips) failed to follow up, 50 (58 hips) were followed up, but 6 (7 hips) were due to the follow-up. Secondary revision surgery was excluded from this study. Forty-four cases (51 hips) were included in the study and evaluated. All the children were mature at the last follow-up.
According to the imaging findings of the last follow-up, the patients were divided into two groups: the non-femoral head necrosis group and the femoral head necrosis group. The correlation between preoperative factors, operative factors and postoperative complications of femoral head necrosis was assessed, and the results of imaging measurements (including CE angle, Sharp angle, femoral neck shaft angle, Reimers index) and acetabulum were analyzed. The correlation between joint Severin typing results and Mckay functional classification results.
Results: The average age at the last follow-up was 15 years and 1 month (13 years and 1 month to 22 years and 4 months). The mean follow-up time was 12 years and 3 months (10 years, 3 months to 19 years and 4 months). There were 32 hips in the non-femoral head necrosis group, including 6 males, 7 females, 25 females, 18 left hips, 14 right hips, 19 unilateral hips and 11 bilateral hips. In the dead group, 19 cases (19 hips), 3 males (3 hips), 16 females (16 hips), 11 left hips, 8 right hips, 11 unilateral hips and 8 bilateral hips were involved. The mean age at operation was 28.4 months.
Statistical analysis (Chi-square test or T test) showed that there was no significant correlation between preoperative and operative factors and postoperative femoral head necrosis. When the preoperative factors affect the complications of femoral head necrosis after operation, there is no significant correlation between the factors at 0.05 level and the occurrence of femoral head necrosis; when the operative factors are considered only, there is no significant correlation between the factors at 0.05 level and the occurrence of femoral head necrosis after operation; when the preoperative and postoperative factors are considered comprehensively, there is no significant correlation between the factors at 0 There was no significant correlation between preoperative factors and femoral head necrosis at 0.05 level, but the difference of acetabular index before and after operation was significantly correlated with femoral head necrosis. The greater the risk.
At the last follow-up, there was no significant difference in CE angle, Sharp angle, femoral neck shaft angle and Reimers index between the two groups (Chi-square test or T test). Hip joints with avascular necrosis of the femoral head are more likely to be classified as superior in Levrin's classification and Meckay's functional classification. Hip joints with avascular necrosis of the femoral head are more likely to be classified as inferior.
Conclusion: Open reduction, Salter pelvic osteotomy for the treatment of femoral head necrosis after developmental dislocation of the hip has no significant correlation with preoperative gender, lateral, unilateral, degree of dislocation and age at the time of surgery; and acetabular index difference before and after surgery has a certain correlation, the greater the difference, the greater the risk of femoral head necrosis, suggesting that femoral head is bad. In addition, the long-term Severin typing of the hip joint in children with avascular necrosis of the femoral head was worse than that in children without avascular necrosis of the femoral head.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.8

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