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目的:通过3DCT观察大龄(≥8岁)发育性髋关节脱位(DDH)手术后残余畸形病理改变，模拟手术预判治疗效果，探讨多种手术方式综合治疗的经验体会。方法:回顾分析山东大学附属省立医院小儿骨科2012年7月至2017年6月综合运用多种截骨术治疗的大龄DDH治疗后残余畸形病例资料共27例35髋，手术时患儿年龄8岁至13岁9个月。根据Tonnis分型，Ⅰ型7髋，Ⅱ型22髋，Ⅲ型6髋。根据Kalamchi & MacEwen股骨头坏死分型，Ⅱ型6髋，Ⅲ型11髋，Ⅳ型8髋，10髋未见坏死。根据Ponseti标准评价髋关节功能，2级3髋，3级6髋，4级4髋，5级12髋，6级10髋。根据改良Severin分类，Ⅱ型3髋，Ⅲ型13髋，Ⅳ型12髋，Ⅴ型7髋。术前摄骨盆-双股骨全长CT。CT数据导入Mimics软件中建立3D骨模型。根据患儿年龄和头臼匹配情况模拟相应截骨术，观察截骨后股骨头覆盖和关节匹配情况，据此行手术治疗。以配对样本 n t检验比较手术前后Reimer指数和Sharp角的变化，n P<0.01为差异有统计学意义，评价随访时影像学效果和关节功能恢复情况。以改良Severin分类评价影像学效果，以Ponseti标准评价关节功能。n 结果:随访时间13～36个月。末次随访时Reimer指数由0.54±0.24改善至0.19±0.08，Sharp角由53°±8°改善至38°±6°，与术前相比差异均有统计学意义(n P均<0.01)。按改良Severin分类，Ⅰ型5髋为优，Ⅱ型19髋为良，Ⅲ型11髋为可，优良率为68%(24/35)。按Ponseti标准，1级17髋，2级11髋，3级7髋，优良率80%(28/35)。n 结论:在3DCT模拟手术的辅助下，综合运用多种手术方式治疗大龄DDH手术后残余畸形可缓解关节疼痛并改善跛行步态，早期效果良好，值得临床推广应用。“,”Objective:To observe the pathological changes of residual deformities of developmental dislocation of the hip (DDH) in elder children (≥8 years) with three-dimensional computed tomography (3DCT), predict the therapeutic effect by simulating operation and to summarize the experiences of comprehensive treatment of various surgeries.Methods:Clinical data were retrospectively analyzed for 27 cases (35 hips) of residual deformity after multiple osteotomies in elder children with DDH from July 2012 to June 2017. The operative age was from 8 years to 13 years and 9 months. According to the Tonnis classification, the types were Ⅰ (7 hips), Ⅱ (22 hips) and Ⅲ (6 hips). According to the Kalamchi & MacEwen classification of osteonecrosis of femoral head, the types were Ⅱ (6 hips), Ⅲ (11 hips), Ⅳ (8 hips) and non-necrosis (10 hips). According to the Ponseti criteria, the grade of hip function was Ⅱ (3 hips), Ⅲ (6 hips), Ⅳ (4 hips), Ⅴ (12 hips) and Ⅵ (10 hips). According to the modified Severin classification, the types were Ⅱ (3 hips), Ⅲ (3 hips), Ⅳ (12 hips) and Ⅴ (7 hips). Full-length computed tomography (CT) was performed for bilateral pelvis-femurs. The corresponding osteotomy was simulated according to age and matching level of head and socket. Femoral head coverage and joint matching after osteotomy were observed postoperatively. The pre/post-operative changes in Reimer index and Sharp angle were compared by paired sample t-test and n P<0.01 was considered statistically significant for evaluating the radiographic effect and joint function recovery during follow-ups. Radiographic effects were evaluated by the modified Severin classification and joint function by the Ponseti criteria.n Results:During a follow-up period of 13-36 months, Reimer index improved from (0.54±0.24) to (0.19±0.08) and Sharp angle gained from (53°±8°) to (38°±6°). And the differences were statistically significant (n P<0.01). According to the modified Severin classification, the outcomes were excellent (5 hips, type Ⅰ), decent (19 hips, type Ⅱ) and fair (11 hips, type Ⅲ). And the excellent-decent rate was 68% (24/35). According to the Ponseti criteria, the grade was Ⅰ(17 hips), Ⅱ(11 hips) and Ⅲ(7 hips). And the excellent-decent rate was 80% (28/35).n Conclusions:Hip pain may be relieved and limping gaits improved by comprehensive applications of various surgeries assisted with 3DCT simulating operation for residual deformities after DDH operations in elder children. With a definite early efficacy, the method should be popularized in clinical practices.