摘要
目的 探讨联合后外侧辅助入路髋臼周围截骨术(periacetabular osteotomy,PAO)治疗髋关节发育不良(de-velopmental dysplasia of hip,DDH)的临床疗效.方法 回顾性分析2016年1月至2021年1月于解放军联勤保障部队第九二○医院及中南大学湘雅二医院采用联合后外侧辅助入路PAO治疗并获得随访的DDH患者85例(97髋),男15例、女70例,年龄(28.6±8.4)岁(范围12～49岁).97髋均为Hartofilakidis分型Ⅰ型,髋关节骨关节炎Tönnis分级0级77髋、1级20髋.所有患者均采用改良Smith-Petersen或Bikini入路联合后外侧辅助小切口完成PAO治疗.术前与术后随访时行X线检查,应用疼痛视觉模拟评分(visual analogue scale,VAS)和改良Harris评分(modified Harris hip scores,mHHS)评估疗效,于X线片上观察髋臼外侧中心边缘角(lateral central edge angle,LCEA)、臼顶倾斜角(Tönnis angle,TNS)和髋臼前侧中心边缘角(anterior central edge angle,ACEA),使用累积和方法对手术时间的学习曲线进行拟合.结果 85例(97髋)患者均获得随访,随访时间为(52.7±18.9)个月(范围21～84个月).手术时间和术中出血量分别为(95.9±28.2)min(范围65～215 min)和(414.7±97.0)ml(范围250～900 ml),手术时间学习曲线例数为10例.术后LCEA为32.39°(30.29°,34.92°),较术前的 5.37°(1.25°,9.25°)增加,差异有统计学意义(Z=-30.764,P＜0.001);术后TNS为3.14°(1.56°,5.67°),较术前的25.11°(21.19°,31.11°)降低,差异有统计学意义(Z=30.595,P＜0.001);术后 ACEA 为 31.55°(29.07°,33.88°),较术前的 1.39°(0.22°,6.30°)增加,差异有统计学意义(Z=-38.134,P＜0.001).VAS由术前的(5.18±0.88)分降低至末次随访的(1.27±0.93)分,差异有统计学意义(t=51.231,P＜0.001);mHHS由术前(73.12±9.17)分提高至末次随访(92.02±4.05)分,差异有统计学意义(t=-26.902,P＜0.001).随访期间无患者需行髋关节置换术.结论 经改良Smith-Petersen或Bikini入路联合后外侧辅助小切口 PAO是治疗DDH安全、有效的方法,且联合入路可缩短学习曲线、降低操作复杂度.
Abstract
Objective To investigate the outcomes of periacetabular osteotomy(PAO)through modified Smith-Petersen or Bikini approach with an auxiliary posterolateral incision for developmental dysplasia of hip(DDH).Methods 85 patients(97 hips)who underwent PAO through modified Smith-Petersen or Bikini approach with auxiliary posterolateral incision for DDH in the 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army or the Second Xiangya Hospital of Central South University from January 2016 to January 2021 were retrospectively analyzed.There were 70 females and 15 males,with an average age of 28.6±8.4 years(12-49).According to the Hartofilakidis classification,all patients were classified as type Ⅰ.There were 77 hips classified as Grade 0 and 20 hips classified as Grade 1 according to the Tönnis classification.The X-ray evaluation including the lateral central edge angle(LCEA),tönnis angle(TNS)and anterior central edge angle(ACEA),visual analogue score(VAS)and modified Harries hip score(mHHS)were recorded preoperatively and during each postoperative follow-up.The cumula-tive sum(CUSUM)method was used to fit the learning curves of operation time.Results All patients were followed-up with an av-erage of 52.7±18.9 months(21 to 84).The average operative time and intraoperative blood loss were 95.9±28.2 min(65 to 215)and 414.7±97.0 ml(250 to 900),respectively.The learning curve of operation time was 10 cases.The average LCEA 32.39°(30.29°,34.92°),TNS 3.14°(1.56°,5.67°)and ACEA 31.55°(29.07°,33.88°)were all significantly improved compared to preoper-ative values(Z=-30.764,P＜0.001;Z=30.595,P＜0.001;Z=-38.134,P＜0.001).The average VAS was reduced from 5.18±0.88 points preoperatively to 1.27±0.93 points postoperatively with significant difference(t=51.231,P＜0.001).The average mHHS was increased from 73.12±9.17 to 92.02±4.05 postoperatively with significant difference(t=-26.902,P＜0.001).No patients received total hip arthroplasty during the follow-up period.Conclusion Bernese PAO through modified Smith-Petersen or Bikini ap-proach with a small auxiliary posterolateral incision was not only a safe and effective method for the treatment of DDH but also shortened the learning curve and reduced difficulty of the surgery.
维普
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