目的 探讨髋臼周围截骨联合股骨转子间截骨术治疗复杂性髋关节发育不良(DDH)的临床疗效.方法回顾性分析2010年1月至2014年4月宜昌市中心人民医院和华中科技大学协和医院骨科收治的33例复杂性DDH患者的临床资料,患者均接受髋臼周围截骨联合股骨转子间截骨术.术后随访36个月,评价治疗效果,记录骨愈合时间;比较术前、术后外侧CE角、颈干角(外翻、内翻)差异,以及Harris髋关节评分、疼痛视觉模拟评分法(VAS)评分.结果33例患者骨愈合时间为(3.0±0.6)个月.术后患者外侧CE角和髋内翻颈干角均高于术前[(28.7±3.2)°比(5.6±1.8)°,(130.0±3.8)°比(108.0±5.1)°](P<0.01),髋外翻颈干角低于术前[(128.6±3.8)°比(155.2±8.9)°](P<0.01);术后患者Harris髋关节评分高于术前[(89.97±4.31)分比(75.64±5.13)分](P<0.01)、VAS评分低于术前[(1.33±0.51)分比(5.04±1.52)分](P<0.01).随访3年,33例患者中发生轻度跛行3例,占9.0%;股外侧皮神经损伤5例,占15.2%,无股骨头坏死、截骨不愈合、股骨颈骨折病例发生,总并发症发生率为24.2%(8/33).结论髋臼周围截骨联合股骨转子间截骨术可有效矫正复杂性DDH患者髋关节畸形,且未增加术后并发症发生风险,安全有效.%Objective To evaluate the effect of acetabular osteotomy combined with femoral intertrochanteric osteoto-my in treatment of complex development dysplasia hig (DDH)patients. Methods The clinial data of 33 complex DDH patients in orthopedics department of Yichang Central People′s Hospital and Union Hospital of Huazhong University of Sci-ence and Technology from Jan. 2010 to Apr. 2014 were analyzed retrospectively. The patients were accepted acetabular osteotomycombined with intertrochanteric osteotomy. During the 36 months of follow-up,the therapeutic effects were evalua-ted,bone healing time was recorded . The angles of the lateral CE angle and the neck dry angle(valgus and varus)were compared at the 36 months after the surgery,and the Harris hip score and the pain visual analogue scale(VAS)score were compared. Results The bone healing time was (3. 0 ± 0. 6)months. After the operation,the CE lateral hip varus angle and neck shaft were higher than before treatment[(28. 7 ± 3. 2)° vs (5. 6 ± 1. 8)°,(130. 0 ± 3. 8 )° vs (108. 0 ± 5. 1)°] (P < 0. 01),and the angle of hip valgus neck was lower than before treatment[(128. 6 ± 3. 8)° vs (155. 2 ± 8. 9)°](P <0. 01). After the operation,the Harris of hip score was higher than before treatment [(89. 97 ± 4. 31 )scores vs (75. 64 ± 5. 13)scores](P < 0. 01),and the VAS score was lower than before treatment[(1. 33 ± 0. 51 )score vs (5. 04 ± 1. 52) score](P < 0. 01). During the 36 months of follows-up,there were three cases of mild claudication in 33 cases,accounting for 9. 0%;5 cases had lateral femoral cutaneous nerve injuries,accounting for 15. 2%;no femoral head necrosis,nonun-ion,femoral neck fracture occurred,and the total complication rate was 24. 2% (8 / 33). Conclusion Periacetabular osteotomycombined with femoral intertrochanteric osteotomy can effectively correct the deformity of hip joint of the patients with complex DDH,and do not increase the risk of postoperative complications,it is safe and effective.
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