可吸收棒内固定在儿童Perthes病骨盆三联截骨术治疗中的应用

摘要

Objective To evaluate the feasibility,efficacy and advantage of triple pelvic osteotomy with absorbable rods fixation for the treatment of Perthes disease.Methods From April 2007 to December 2014,74 cases of Perthes disease(79 hips) were collected in this study.According to Catterall's classification,there were 59 hips of grade Ⅲ and 20 hips of grade Ⅳ.All patients were treated by Pol Le Coeur's triple osteotomy with self-reinforced absorbable (SR-PLLA) rods fixation at iliac osteotomy sites.Results All cases were followed up for 14 months to 93 months,with an average of 46 months.According to the criteria of Mckay for the disease's functional prognosis,there were 51 cases with excellent hip function,15 cases with good hip function and 8 cases with fair hip function,the "excellent" and "good" rate reached up to 88.61％.Radiographic images revealed that all osteotomy bones were healed without loosening of fixation,acetabular fragment migration,iliac bone grafts osteolysis or dislocation.The percentage coverage of the femoral head improved from average 75.06％ before operation to 95.70％ at final follow-up (t =-32.06,P ＜ 0.001).The average epiphyseal height ratio was 65.49％ before operation,and it was 80.86％ at final review (t =-48.13,P ＜ 0.001).The initial CE angle was 16.22°,which finally increased to 34.47°(t =-44.58,P ＜ 0.001).The average Sharp angle was decreased from 41.46° before surgery to 24..16° after operation (t =51.44,P ＜ 0.001).Conclusion Absorbable rods instead of kirschner wires or screws used for fixing osteotomy sites in triple pelvic osteotomy is a simple,reliable and effective way to treat cutting pelvis and iliac bone grafts in Perthes disease.The operation did not receive obvious adverse reactions and can surely avoid the secondary removal operation.%目的 评估儿童Perthes病骨盆三联截骨术中应用可吸收棒内固定治疗的可行性、疗效及优势. 方法 收集2007年4月至2014年12月间由本院收治的74例(79髋)儿童Perthes病的患儿,按Catterall分型:Ⅲ型59髋,Ⅳ型20髋,均采用Pol Le Coeur骨盆三联截骨联合可吸收棒内固定术治疗. 结果 术后随访14个月至7年9个月(平均46个月),根据Mckay标准,本组病例术后髋关节功能优51例(53髋),良15例(17髋),可8例(9髋),优良率为88.61％.术后随访X线片显示骨盆截骨植骨处固定良好,无植骨块松动移位及骨吸收病例发生.患髋髋臼覆盖率由术前75.06％的平均值增加至术后的95.70％,差异有统计学意义(t=-32.06,P＜0.001);术前患髋骺高比平均为65.49％,术后平均为80.86％,差异有统计学意义(t=-48.13,P＜0.001);CE角由术前平均16.22.增加至34.47.,差异有统计学意义(t=-44.58,P＜0.001);而Sharp角则由术前的41.46.降至术后的24.16.,差异有统计学意义(t=51.44,P＜0.001). 结论 可吸收棒代替克氏针或金属螺钉应用于儿童Perthes病三联截骨术中髂骨截骨处的固定,疗效满意,操作简单,固定牢靠,无明显不良反应,可避免二次手术创伤.