摘要目的 探讨股骨近端转子间旋转楔形截骨在发育性髋关节发育不良(developmental dysplasia of the hip,DDH)髋臼周围截骨术(periacetabular osteotomy,PAO)中的应用。方法 收集2022—2023年西安市红会医院风湿免疫关节矫形科收治的发育性DDH患者共5例,均为女性患者,年龄24~38岁,平均(30.12±6.58)岁。5例患者均为单侧手术。术中先行PAO术,待螺钉固定后,透视假斜位,见股骨头的前覆盖仍不足,遂考虑行减少股骨颈前倾角的股骨近端截骨术(proximal femoral osteotomy,PFO)。记录并比较术前及术后6个月髋关节外侧中心边缘角(lateral central edge angle,LCEA)、髋关节假斜位上的前侧中心边缘角(anterior central edge angle,ACEA)、Tnnis角以及髋关节Harris评分、国际髋关节功能(international hip outcome tool,iHOT-12)评分。结果 5例患者均获随访,随访时间12~15个月,平均(13.6±1.14)个月。术后3个月复查时,X线片示截骨处均已完全骨性愈合。术后6个月髋关节LCEA、ACEA、Tnnis角、髋关节Harris评分、iHOT-12评分均较术前明显改善(P<0.05)。髋关节Harris评分均>90分,iHOT-12评分均>85分。结论 PFO术中采用股骨近端转子间旋转楔形截骨的手术技术,可以相对简单地矫正DDH患者较大的股骨侧畸形,辅助PAO使髋臼对股骨头的包裹更加充分。
[1]程徽,张洪.成人发育不良髋关节的前覆盖测量方法[J].中华骨科杂志,2022,42(17):1165-1174.
[2]李杰,龙江涛,王倩倩,等.发育性髋关节脱位患儿不同股骨颈前倾角对股骨生物力学的影响研究[J].临床小儿外科杂志,2023,22(8):757-761.
[3]谷旺,程楠楠,张振东,等.髋关节发育不良伴股骨颈前倾角异常增大成人患者联合截骨术的疗效[J].生物骨科材料与临床研究,2023,20(4):4-8.
[4]Sonoda K,Motomura G,Ikemura S,et al.Effects of intertrochanteric osteotomy plane and preoperative femoral anteversion on the postoperative morphology of the proximal femur in transtrochanteric anterior rotational osteotomy:3D CT-based simulation study[J].Orthop Traumatol Surg Res,2017,103(7):1005-1010.
[5]Ganz R,Horowitz K,Leunig M.Algorithm for femoral and periacetabular osteotomies in complex hip deformities[J].Clin Orthop Relat Res,2010,468(12):3168-3180.
[6]罗殿中,张洪,张伟佳.髋臼周围截骨三种手术人路比较[J].实用骨科杂志,2013,19(6):481-484.
[7]Robertson DD,Essinger JR,Imura S,et al.Femoral deformity in adults with developmental hip dysplasia[J].Clin Orthop Relat Res,1996,3(27):196-206.
[8]Noble PC,Kamaric E,Sugano N,et al.Three-dimensional shape of the dysplastic femur:implications for THR[J].Clin Orthop Relat Res,2003 (417):27-40.
[9]Clohisy JC,Nunley RM,Carlisle JC,et al.Incidence and characteristics of femoral deformities in the dysplastic hip[J].Clin Orthop Relat Res,2009(467):128-134.
[10]Iwase T,Hasegawa Y,Kawamoto K,et al.Twenty years’follow up of intertrochanteric osteotomy for treatment of the dysplastic hip[J].Clin Orthop Relat Res,1996(331):245-255.
[11]Siebenrock KA,Steppacher SD,Haefeli PC,et al.Valgus hip with high antetorsion causes pain through posterior extraarticular FAI[J].Clin Orthop Relat Res,2013,471(12):3774-3780.
[12]Wyles CC,Heidenreich MJ,Jeng J,et al.The John Charnley award:Redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement[J].Clin Orthop Relat Res,2017,475(2):336-350.
[13]中华医学会骨科学分会关节外科学组.中国发育性髋关节发育不良诊疗指南(2023版)[J].中华解剖与临床杂志,2023,28(8):493-511.
[14]Tonnis D,Heinecke A.Acetabular and femoral anteversion:Relationship with osteoarthritis of the hip[J].J Bone Joint Surg(Am),1999,81(12):1747-1770.