切开复位、Salter骨盆截骨联合股骨近端旋转短缩截骨术治疗儿童发育性髋关节脱位的疗效分析

Open reduction，salter acetabular osteotomy，combined with proximal femoral rotation osteotomy in the treatment of pediatric developmental dysplasia of the hip

摘要:

目的：探讨切开复位、Salter骨盆截骨联合股骨近端旋转短缩截骨术治疗儿童发育性髋关节脱位的疗效。方法：回顾性分析我院2006年1月至2012年1月收治的儿童发育性髋关节脱位患儿116例，均采用切开复位、salter骨盆截骨联合股骨近端旋转短缩截骨术，男76例，女40例；左侧40例，右侧66例，双侧10例；年龄1.5～6.5岁，平均3.4岁；按Tonnis股骨头脱位程度：Ⅱ度6例，Ⅲ度72例，Ⅳ度38例，双侧脱位患儿首次手术后3～6个月行对侧手术。结果：术后随访2～4.6年，平均3.2年，临床随访结果按照Mckay功能评定标准，优75.40%，良19.84%，可3.97%，差0.79%,优良率95.24%，术后X线按照severin评分标准，优73.81%，良21.43%，可3.17%，差1.59%，优良率95.24%，术后有1例再脱位，1例半脱位，2例股骨头缺血性坏死，2例髋关节功能障碍。结论：严格掌握手术适应症及手术技巧，切开复位、Salter骨盆截骨联合股骨近端旋转短缩截骨术治疗儿童发育性髋关节脱位，术后髋关节功能恢复满意，是一种值得推广的有效的手术方式。

Abstract:

Objective：To evaluate the treatment of open reduction，salter acetabular osteotomy，combined with proximal femoral rotation osteotomy for pediatric developmental dysplasia of the hip. Methods：Retrospective analysis from January 2006 to June 2012 was con－ducted and a total of 116 children with developmental dysplasia of the hip were enrolled including 76 males and 40 females（left 40 cases，right 66 cases，both 10 cases）; the average age was 3.4 years old（1.5-6.5 years old）. According to the Tonnies classification system，there were 6 type Ⅱ，72 type Ⅲ，38 type IV；operation on the other side was performed at three months after the first opera－tion. Results：All the patients were available at the final follow up with a mean of 2.4 years old（2.0-4.6 years old）. According to the standard functional evaluation of Mckay，there were 75.40% excellent，19.84% good，3.97% better and 0.97% poor，According to the standard functional evaluation of severin，there were 73.81% excellent，21.43% good，3.17% better and 1.59% poor. One case of redis－location，one case of subluxation，two cases of avascular necrosis of femoral head，and two cases of stiffness of the hip joint were ob－served. Conclusion：The operation indications and surgical skills should be mastered strictly. The treatment of open reduction，salter acetabular osteotomy，combined with proximal femoral rotation osteotomy for pediatric developmental dysplasia of the hip can chieve good results，therefore it should be promoted.