Duan Jiahua,Zheng Pengfei,Hu Xinyue,et al.Efficacy of femoral osteotomy for children aged 2-3 years with T?nnis Grade Ⅱ developmental dysplasia of the hip[J].Journal of Clinical Pediatric Surgery,2021,20(02):172-176.[doi:10.12260/lcxewkzz.2021.02.012]
股骨近端截骨对2~3岁TonnisⅡ型发育性髋关节发育不良患者治疗效果的研究
- Title:
- Efficacy of femoral osteotomy for children aged 2-3 years with T?nnis Grade Ⅱ developmental dysplasia of the hip
- 关键词:
- 发育性髋关节发育不良/外科学; 股骨; 截骨术; 治疗结果; 儿童
- 分类号:
- R687.3 R681.1
- 摘要:
- 目的 比较分析股骨近端短缩截骨与不截骨对2~3岁TonnisⅡ型发育性髋关节发育不良（developmental dysplasia of the hip，DDH）患者手术后疗效的影响，探讨该类型DDH患者的最佳治疗策略。方法 回顾性分析2016年1月至2017年12月南京医科大学附属儿童医院收治的48例2~3岁TonnisⅡ型DDH（48髋）患者的临床资料，其中男4例，女44例，年龄24~34个月，平均年龄28.6个月。根据股骨近端截骨与否分为股骨不截骨组（n=21）和股骨截骨组（n=27）。采用Mckay标准评估术后髋关节功能，Severin标准评估影像学评分，评估股骨头缺血性坏死（avascular necrosis，AVN）发生率及髋关节再脱位率，根据以上指标比较两组患者的治疗效果。结果 48例患者的平均随访时间22.1个月（17~27个月）。股骨不截骨组有2例（2/21，9.5%）发生AVN，股骨截骨组有3例（3/27，11.1%）发生AVN，差异无统计学意义（χ2=0.032，P=0.858）。股骨不截骨组Mckay评分19例为优，2例为良；股骨截骨组Mckay评分23例为优，4例为良；差异无统计学意义（χ2=0.302，P=0.582）。股骨不截骨组Severin评分优17例，良4例；股骨截骨组Severin评分优20例，良7例；差异无统计学意义（χ2=0.316，P=0.574）。两组均无一例发生髋关节再脱位。结论 对于2~3岁TonnisⅡ型DDH患者行切开复位手术时不推荐常规应用股骨短缩截骨术。
- Abstract:
- Objective To compare the clinical outcomes after open reduction with and without femoral shortening for children aged 2 to 3 years with Tonnis grade Ⅱ developmental dysplasia of the hip(DDH).Methods From January 2016 to December 2017,48 children aged 2 to 3 years with Tonnis grade ⅡDDH(48 hips)were retrospectively reviewed.There were 21 hips in femoral non-shortening group and 27 hips in femoral shortening group.The average age was 28.6(25-34)months.The Severin criteria were used for evaluating the imaging scores.And avascular necrosis(AVN)and redislocation rate were employed for judging the therapeutic outcomes.Results The mean follow-up period was 22.1(17-27)months.Femoral non-shortening group:2 AVN cases(2/21,9.5%),the outcomes were excellent(n=19)and decent(n=2)using the modified McKay criteria,excellent(n=17)and decent(n=4)using the Severin scale,no redislocation;femoral shortening group:3 AVN cases(3/27,11.1%),excellent(n=23)and decent(n=4)using the modified McKay criteria,excellent(n=20)and decent(n=7)using the Severin scale and no redislocation.No statistically significant differences existed in modified McKay criteria,Severin score or AVN rate.Conclusion Femoral shortening is not recommended for children aged 2-3 years with Tonnis gradeⅡ DDH.
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备注/Memo
收稿日期:2020-02-20。
基金项目:江苏省"科教强卫工程"青年医学人才项目（编号：QNRC2016094）
通讯作者:楼跃,Email:yuelounjmu@sina.com