临床小儿外科杂志

目的探讨双侧Salter骨盆截骨术治疗发育性髋关节脱位的安全性和远期疗效。方法随访双侧同时行Salter骨盆截骨术的发育性双侧髋关节脱位患儿共17例,34髋作为观察组,另选取同时期进行分次Salter骨盆截骨术的双侧髋关节脱位患儿18例,36髋作为对照组。比较两组术后关节功能、髋臼X线表现、并发症发生率。并测量比较髋臼指数及中小边缘角。结果平均随访9年6个月,观察组和对照组最后一次随访Sharp角分别为38.4°±8.23°和37.2°±9.03°; 中心边缘角分别为26.7°±8.23°和26.2°±9.03°。按Mckay髋关节功能评价标准,观察组术后优良率为91.18%,对照组为88.89%; 按Severin标准评定X线表现,观察组术后优良率为88.24%,对照组为94.45%; 股骨头坏死率病例组为11.76%,对照组为13.89%; 髋关节功能不良发生率在病例组及对照组分别为8.82%和8.33%。两组各项差异无统计学意义(P>0.05)。结论双侧同时行Salter骨盆截骨与分次Salter骨盆截骨远期疗效相似,双侧Salter骨盆截骨治疗发育性双侧髋关节脱位安全有效。

Objective To evaluate the long-term efficacy of bilateral Salter osteotomies for developmental dysplasia of bilateral hips. Methods This study retrospectively compared the clinical and radiological outcomes of patients with bilateral developmental dysplasia of the hip who underwent either a single-stage operation with Salter innominate osteotomy or a two-stage procedure comprising consecutive operations.Extensive pre-and postoperative clinical,surgical and radiological examinations were undertaken. Results 17 cases(34 hips,study cases)with developmental dysplasia of bilateral hips were observed,who were treated with bilateral Salter ostotomies,another 18 patients(36 hips)underwent consecutive operations were served as controls.The mean follow-up was 9.5(8.1-10.4)years.There were no significance between two groups in acetabular index or centre-edge angle correction.The excellent to good rate for Severin classification and modified McKay criteria were88.24%、91.18% respectively in study cases,while 94.45%,88.89%in control group.The incidence of avascular necrosis of the femoral head were 11.76%and 13.89% respectively in study cases and control cases.Differences in main variables were not found to be significantly different between two groups. Conclusion Bilateral Salter osteotomies can provide satisfied effect similar to consecutive Salter osteotomy,and bilateral dysplasia treated with one-stage Salter osteotomies could be safe and effective.

引言
1 材料与方法
2 结果
3 讨论

图1 患儿女,手术年龄3岁2个月,曾行双侧髋关节切开复位术,残余髋臼发育不良。A:术前骨盆平片; B:双侧Salter骨盆截骨术后6周; C:术后6个月; D:术后5年1个月; E:术后8年5个月<br/>Fig.1 A 3-years-old female patient with developmental dysplasia of bilateral hips,who had bilateral hip open reduction surgery,with residual acetabular dysplasia.A:preoperative film; B,C,D,E:pelvic radiograph after surgery of 6 weeks,6months,5yearsand 8years after Bilateral Salter osteotomies respectively.

图1 患儿女,手术年龄3岁2个月,曾行双侧髋关节切开复位术,残余髋臼发育不良。A:术前骨盆平片; B:双侧Salter骨盆截骨术后6周; C:术后6个月; D:术后5年1个月; E:术后8年5个月
Fig.1 A 3-years-old female patient with developmental dysplasia of bilateral hips,who had bilateral hip open reduction surgery,with residual acetabular dysplasia.A:preoperative film; B,C,D,E:pelvic radiograph after surgery of 6 weeks,6months,5yearsand 8years after Bilateral Salter osteotomies respectively.

表1 观察组与对照组术前、术后髋臼指数(Sharp角)变化(x^-±s)<br/>Table 1 Preoperative and postoperative values of acetabular index(or Sharp degree)in two groups(x^-±s)

表1 观察组与对照组术前、术后髋臼指数(Sharp角)变化(x^-±s)
Table 1 Preoperative and postoperative values of acetabular index(or Sharp degree)in two groups(x^-±s)

表2 观察组与对照组术后中心边缘角的变化(x^-±s)<br/>Table 2 Preoperative and postoperative values of CEA in two groups(x^-±s)

表2 观察组与对照组术后中心边缘角的变化(x^-±s)
Table 2 Preoperative and postoperative values of CEA in two groups(x^-±s)

表3 Salter骨盆截骨术后临床随访结果(Makay标准)[n(%)]<br/>Table 3 Clinical follow-up outcomes of two groups afterSalter innominate osteotomy[n(%)]

表3 Salter骨盆截骨术后临床随访结果(Makay标准)[n(%)]
Table 3 Clinical follow-up outcomes of two groups afterSalter innominate osteotomy[n(%)]

表4 观察组与对照组Salter骨盆截骨术后远期随访髋关节功能状况比较(n)<br/>Table 4 Long-term results of hip joint function afterSalter innominate osteotomy between observ-ation group and control group(n)

表4 观察组与对照组Salter骨盆截骨术后远期随访髋关节功能状况比较(n)
Table 4 Long-term results of hip joint function afterSalter innominate osteotomy between observ-ation group and control group(n)

表5 观察组与对照组Salter骨盆截骨术后X线随访结果(Severin标准)[n(%)]<br/>Table 5 Radiological outcomes of two groups after Salter innominate osteotomy[n(%)]

表5 观察组与对照组Salter骨盆截骨术后X线随访结果(Severin标准)[n(%)]
Table 5 Radiological outcomes of two groups after Salter innominate osteotomy[n(%)]

表6 观察组与对照组观察组与对照组Salter骨盆截骨术后远期X线随访结果比较(n)<br/>Table 6 Long-term results of radiological outcomes follow-up after Salter innominate osteotomy between obs-ervation group and control group(n)

表6 观察组与对照组观察组与对照组Salter骨盆截骨术后远期X线随访结果比较(n)
Table 6 Long-term results of radiological outcomes follow-up after Salter innominate osteotomy between obs-ervation group and control group(n)

表7 观察组与对照组Salter骨盆截骨术后并发症发生情况比较[n(%)]<br/>Table 7 The comparison of postoperative complications between observation group and control group [n(%)]

表7 观察组与对照组Salter骨盆截骨术后并发症发生情况比较[n(%)]
Table 7 The comparison of postoperative complications between observation group and control group [n(%)]

1 尚杰,朱小春,俞刚,等.先天性腹裂治疗体会[J].临床小儿外科杂志,2008,7(04):46 — 48.DOI:10.3969/j.issn.1671 — 6353.2008.02.016.
2 姜子非,徐旭军,贺早.巨型脐膨出的治疗探讨[J].中华小儿外科杂志,2005,26(5):279 — 280.DOI:10.3760/cma.j.issn.0253 — 3006.2005.05.019.
3 Vargo JD,Larsen MT,Pearson GD,et al.Component Separation Technique for Repair of Massive Abdominal Wall Defects at a Pediatric Hospital[J].Ann Plast Surg,2016,77(5):555 — 559.DOI:10.1097/SAP.0000000000000652.
4 严文波,潘伟华,武志祥,等.新生儿先天性腹裂外科处理后转归[J].临床外科杂志,2016,24(11):879 — 881.DOI:10.3969/j.issn.1005 — 6483.2016.11.027.
5 吴哗明,Donald C liu.应用免缝silo袋分期治疗新生儿腹裂临床研究[J].中国实用儿科杂志,2004,19(1):31 — 32.DOI:1005 — 2224(2004)01 — 0031 — 02.
6 郑珊,沈淳,黄炎磊,等.I期无缝合肠管回纳法治疗先天性腹裂[J].中华小儿外科杂志,2006,27(10):519 — 521.DOI:10.3760/cma.j.issn.0253 — 3006.2006.10.005.
7 梁玉坚,徐玲玲,唐雯.2013版儿童腹腔内压力和腹腔间隙综合征国际指南解读[J].中华危重病急救医学,2014,7(26):454 — 457.DOI:10.3760/cma.j.issn.2095 — 4352 — 2014.07.002.
8 Kim S,Betts J,Yedlin S,et al.Use of pulse oximeter placed on a gastroschisis silo to monitor intestinal oxygen saturation[J].Pediatr Surg Int,2006,22(9):763 — 765.DOI:10.1007/s00383 — 006 — 1726 — 4.
9 Ross AR,Eaton S,Zani A,et al.The role of preformed silos in the management of infants with gastroschisis:a systematic review and meta analysi[J].Pediatr Surg Int,2015,31(5):473 — 483.DOI:10.1007/s00383 — 015 — 3691 — 2.
10 Cowan KN,Puligandla PS,Laberge JM,et al.The gastroschisis prognostic score:reliable outcome prediction in gastroschisi[J].J Pediatr Surg,2012,47(6):1111 — 1117.DOI:10.1016/j.jpedsurg.2012.03.010.
11 Islan S.Advances in surgery for abdominal wall defects Gastroschisis and omphalocel[J].Clin Perinatol,2012,39(2):375 — 386.DOI:10.1016/j.clp.2012.04.008.
12 Ghionzoli M,James CP,David AL,et al.Gastroschisis with intestinal atresia-predictive value of antenatal diagnosis and outcome of postnatal treatmen[J].J Pediatr Surg,2012,47(2):322 — 328.DOI:10.1016/ j.jpedsurg.2011.11.022.
13 肖兆勇,伏文钧,孙玉振.I期修补术治疗新生儿脐膨出13例[J].实用临床医药杂志,2005,7(9):53 — 54.DOI:1672 — 2353(2005)07 — 0053 — 01.
14 Hougland KT,Hanna AM.Meyers R,et al.Increasing preva1ence of gastroschisis in Utah[J].J Pediatr Surg,2005,40:535 — 540.DOI:10.1016/j.jpedsurg.2004.11.026.
15 Frybova B,Vlk R,Kokesova A,et al.Isolated prenatal ultrasound findings predict the postnatal course in gastroschisi[J].Pediatr Surg Int,2015,31(4):381 — 387.DOI:10.1007/s00383 — 015 — 3675 — 2.
16 Kimble RM,Singh SJ,Bourke C,et al.Gastroschisis reduction under analgesia in the neonatal unit[J].J Pediatr Surg,2001,36(11):1672 — 1674.DOI:10.1053/jpsu.2001.27957.

备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论