中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (15): 2380-2384.doi: 10.3969/j.issn.2095-4344.3813

• 骨科植入物 orthopedic implant • 上一篇    下一篇

Salter骨盆截骨及植入物内固定治疗儿童发育性髋关节脱位的中长期随访

刘永裕1，徐景利2，林天烨2，吴  峰1，沈楚龙1，熊冰朗2，邹启昭2，赖启忠2，张庆文3   

  1. 1佛山市中医院，广东省佛山市   528000；2广州中医药大学第一临床医学院，广东省广州市   510080；3广州中医药大学第一附属医院关节骨科，广东省广州市   510080
  • 收稿日期:2020-06-10 修回日期:2020-06-16 接受日期:2020-07-14 出版日期:2021-05-28 发布日期:2021-01-05
  • 通讯作者: 张庆文，硕士，主任中医师，广州中医药大学第一附属医院关节骨科，广东省广州市 510000
  • 作者简介:刘永裕，男，1980年生，广东省中山市人，2010年广州中医药大学毕业，硕士，副主任中医师，主要从事中医骨伤学方面的研究。
  • 基金资助:
    广东省中医药局科研项目(20201335)，项目负责人：刘永裕

Medium-and long-term follow-up of Salter pelvic osteotomy and implant fixation for children with developmental hip dislocation

Liu Yongyu1, Xu Jingli2, Lin Tianye2, Wu Feng1, Shen Chulong1, Xiong Binglang2, Zou Qizhao2, Lai Qizhong2, Zhang Qingwen3    

  1. 1Foshan Traditional Chinese Medicine Hospital, Foshan 528000, Guangdong Province, China; 2First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guangdong Province, China; 3Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guangdong Province, China 
  • Received:2020-06-10 Revised:2020-06-16 Accepted:2020-07-14 Online:2021-05-28 Published:2021-01-05
  • Contact: Zhang Qingwen, Master, Chief TCM physician, Department of Orthopedics, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guangdong Province, China
  • About author:Liu Yongyu, Master, Associate chief TCM physician, Foshan Traditional Chinese Medicine Hospital, Foshan 528000, Guangdong Province, China
  • Supported by:
    the Scientific Research Project of Guangdong Provincial Bureau of Traditional Chinese Medicine, No. 20201335 (to LYY)

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摘要：

文题释义：
发育性髋关节发育不良：又称发育性髋关节脱位，是儿童骨科最常见的髋关节疾病，发病率为4‰-11‰，女孩的发病率是男孩的6倍左右，双侧约占35%。发育性髋关节发育不良包括髋关节脱位、半脱位和髋臼发育不良。
Salter骨盆截骨：通过截骨后骨盆远端的旋转从而改变髋臼方向，即在髋臼结构和容积保持不变的前提下，增加股骨头前外缘的包容。使异常的髋臼方向变为正常的生理方向，相对增加了髋臼深度。

摘要
背景：儿童发育性髋关节脱位是一种临床常见的儿童骨科髋关节疾病，Salter骨盆截骨治疗此病的短期随访效果满意，目前国内尚缺少中长期的临床随访研究。
目的：探究Salter骨盆截骨治疗儿童发育性髋关节脱位的中长期随访效果及并发症。
方法：回顾性分析广州中医药大学第一附属医院2010年1月至2015年3月收治的发育性髋关节脱位患儿65例(70髋)，采用切开复位、Salter骨盆截骨或Salter骨盆截骨联合股骨近端截骨(锁定加压钢板固定)治疗。按Tonnis分度：Ⅰ度10髋，Ⅱ度17髋，Ⅲ度12髋，Ⅳ度31髋。观察患儿术前及术后中心边缘角、髋臼指数、Sharp角、髋臼深度，术后疗效采用Mckay功能标准及X射线片Severin标准评定。
结果与结论：①65例患儿均获得随访，随访时间5.1-10.2年；②患儿术后髋臼指数及Sharp角均较术前明显减小，中心边缘角、髋臼深度均较术前明显增大，差异均有显著性意义(P < 0.05)；③术后末次随访，按Mckay功能评定标准，优良率为97%；按X射线片Severin评定标准，优良率为90%；④3例患儿出现患侧股骨头坏死，1例患儿出现髋关节再脱位，1例患儿出现股骨近端畸形，1例患儿出现患侧肢体感觉异常；⑤提示Salter骨盆截骨联合股骨近端截骨治疗儿童发育性髋关节脱位中长期随访临床疗效满意，可有效改善患儿髋臼覆盖，提高髋关节功能。

https://orcid.org/0000-0003-0137-9799 (刘永裕) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 骨盆, 髋关节, Salter骨盆截骨, 发育性髋关节脱位, 儿童, 复位

Abstract: BACKGROUND: Developmental dislocation of the hip in children is a common clinical orthopedic hip disease in children. The short-term follow-up effect of Salter pelvic osteotomy is satisfactory. At present, there is still no medium- and long-term clinical follow-up research in China.   
OBJECTIVE: To explore the medium- and long-term clinical effects and complications of Salter pelvic osteotomy in the treatment of developmental hip dislocation in children. 
METHODS: A retrospective analysis of 65 cases (70 hips) of children with developmental hip dislocation admitted from January 2010 to March 2015 in First Affiliated Hospital of Guangzhou University of Chinese Medicine was performed with open reduction, Salter pelvic osteotomy or Salter pelvic osteotomy combined with femur proximal osteotomy (locking compression plate fixation) treatment. According to Tonnis scale, there were degree I in 10 hips, degree II in 17 hips, degree III in 12 hips, and degree IV in 31 hips. Preoperative and postoperative central margin angle, acetabular index, Sharp angle and acetabular depth were observed. The postoperative efficacy was evaluated by McKay function standard and Severin standard of X-ray films. 
RESULTS AND CONCLUSION: (1) All 65 patients were followed up for 5.1-10.2 years. (2) The postoperative acetabular index and Sharp angle were significantly lower than those before the operation; and the central margin angle and acetabular depth were significantly increased compared with the preoperative data. The differences were statistically significant (P < 0.05). (3) In last follow-up after operation, according to Mckay functional evaluation criteria, the excellent and good rate was 97%. According to the final X-ray Severin evaluation standard, the excellent and good rate was 90%. (4) Necrosis of the affected femur occurred in three patients, relocation of the hip in one patient, proximal femoral deformity in one patient, and sensory abnormalities in the affected limb in one patient. (5) The Salter pelvic osteotomy for children with developmental dislocation of the hip has a satisfactory medium- and long-term clinical effect, which can effectively improve the patient’s acetabular coverage and improve hip function. 

Key words: bone, pelvis, hip joint, Salter pelvic osteotomy, developmental dislocation of hip, children, restoration

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