Salter截骨联合股骨截骨治疗TonnisⅡ度发育性髋关节脱位

Clinical effect of Salter osteotomy combined with femoral osteotomy in treatment of Tonnis type Ⅱ developmental dysplasia of the hip

摘要:

目的：评估Salter骨盆截骨联合股骨截骨术治疗Tonnis Ⅱ度发育性髋关节脱位的疗效。方法：采用回顾性病例分析2010年1月至2015年12月期间我院采用Salter骨盆截骨联合股骨截骨术一期手术治疗Tonnis Ⅱ度发育性髋关节脱位患儿28例（33髋），并与单纯Salter截骨术治疗的24例（24髋）进行比较。结果：52例患儿均得到随访，平均26.8个月（12～64个月）。末次随访时，Salter截骨联合股骨截骨术组：髋臼指数（acetabular index，AI）为18.1°±5.2°；中心边缘角（center edge angle，CE角）为36.3°±36.1°；Sharp角为41.4°±4.7°。单纯Salter截骨术组：AI为15.7°±4.8°；CE角为37.8°±11.6°；Sharp角为40.1°±5.0°。Salter截骨联合股骨截骨术组和单纯Salter截骨术组中分别有2髋（2/33）和6髋（6/24）发生股骨头坏死，差异有统计学意义（ χ2=4.131，P=0.042）。根据Severin影像学评价标准，Salter截骨联合股骨截骨术组：优15髋、良11髋、可6髋、差1髋，单纯Salter截骨术组：优5髋、良14髋、可 5髋、差0髋，差异无统计学意义（Z=-1.277，P=0.202）。根据McKay髋关节功能评价标准，Salter截骨联合股骨截骨术组：优17髋、良11髋、可5髋、差0髋，单纯Salter截骨术组：优13髋、良7髋、可4髋、差0髋，差异无统计学意义（Z=-0.107，P=0.915）。结论：Salter截骨联合股骨截骨是治疗Tonnis Ⅱ度发育性髋关节脱位的有效方法，联合股骨截骨可减少股骨头坏死发生率。

Abstract:

Objective：To investigate the clinical effect of Salter osteotomy combined with femoral osteotomy in the treatment of Tonnis type Ⅱ developmental dysplasia of the hip. Methods：A retrospective analysis was performed for the clinical data of 52 children（57 hips） with Tonnis type Ⅱ developmental dysplasia of the hip who underwent surgical treatment in our hospital from January 2010 to December 2015，and among these children，28（33 hips） underwent Salter osteotomy combined with femoral osteotomy and 24（24 hips） underwent Salter osteotomy alone. A comparative analysis was performed for the two groups. Results：All children obtained follow-up，with a mean follow-up time of 26.8 months（range 12-64 months）. At the last follow-up，the Salter osteotomy-femoral osteotomy combination group had an acetabular index（AI） of 18.1°±5.2°，a center edge（CE） angle of 36.3°±36.1°，and a Sharp angle of 41.4°±4.7°，while the Salter osteotomy group had an AI of 15.7°±4.8°，a CE angle of 37.8°±11.6°，and a Sharp angle of 40.1°±5.0°. There was a significant difference in the incidence rate of femoral head necrosis between the Salter osteotomy-femoral osteotomy combination group and the Salter osteotomy group[2 hips（2/33） vs. 6 hips（6/24）， ?字2=4.131，P=0.042]. According to the Severin radiological classification，in the Salter osteotomy-femoral osteotomy combination group，15 hips were excellent，11 hips were good，6 hips were fairly good，and 1 hip was poor，while in the Salter osteotomy group，5 hips were excellent，14 hips were good，5 hips were fairly good，and no hip was poor；there was no significant difference between the two groups（Z=-1.277，P=0.202）. According to McKay’s hip function evaluation criteria，in the Salter osteotomy-femoral osteotomy combination group，17 hips were excellent，11 hips were good，5 hips were fairly good，and no hip was poor，while in the Salter osteotomy group，13 hips were excellent，7 hips were good，4 hips were fairly good，and no hip was poor；there was no significant difference between the two groups（Z=-0.107，P=0.915）. Conclusion：Salter osteotomy combined with femoral osteotomy has a good clinical effect in the treatment of Tonnis type Ⅱ developmental dysplasia of the hip and can effectively reduce the incidence rate of femoral head necrosis.