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目的:探讨联合术式(骨盆截骨+股骨短缩旋转截骨)对不同年龄段儿童发育性髋关节脱位(DDH)的疗效。方法:选择2011年1月至2015年5月手术治疗的DDH患儿31例。依据年龄将其分为1~3岁,4~6岁,>7岁3组。全部病例均行髋关节切开复位,股骨近端短缩旋转截骨,采用Pemberton截骨16髋,Salter截骨20髋。术后采用McKay髋关节功能评价、Severin髋关节影像学评级、CE角及AI角为随访指标,对比不同年龄组患儿的疗效。结果:根据McKay髋关节功能评价标准优良率为86.11%,不同年龄组间功能评价差异具有统计学意义(P<0.05),幼龄组优良率高于大龄组;根据Severin髋关节影像学评级标准优良率为80.56%。术后影像学评估AI角及CE角均较术前明显改善,年龄与术后角度纠正呈负相关关系,差异具有统计学意义(P<0.05)。结论:髋关节切开复位,股骨近端和髋臼截骨联合术式是治疗各年龄段儿童DDH的有效治疗方法,手术疗效与手术治疗的年龄相关,早期治疗术后关节结构及功能改善效果优于大龄治疗者。
Objective: To investigate the effect of combined surgery (pelvic osteotomy + femoral shortening rotary osteotomy) on developmental dislocation of the hip (DDH) in children of different ages. Methods: Thirty-one children with DDH underwent surgery from January 2011 to May 2015. According to their age will be divided into 1 to 3 years old, 4 to 6 years old,> 7 years old 3 groups. All patients underwent hip joint open reduction, proximal femoral rotation osteotomy, using Pemberton osteotomy 16 hips, Salter osteotomy 20 hips. Postoperative McKay hip function evaluation, Severin hip radiography, CE angle and AI angle for the follow-up index, the efficacy of different age groups were compared. Results: According to the McKay hip function evaluation criteria, the excellent and good rate was 86.11%. The functional evaluation among different age groups was statistically significant (P <0.05). The excellent and good rate in young group was higher than that in older group. According to the Severin hip imaging standard Excellent rate of 80.56%. Postoperative radiological assessment of AI angle and CE angle were significantly improved compared with preoperative, and age and postoperative corrections was negatively correlated, the difference was statistically significant (P <0.05). CONCLUSION: Open reduction and total hip arthroplasty are the effective treatment for DDH in children of all ages. The operative effect is related to the age of surgical treatment. The effect of early treatment on postoperative joint structure and function is improved Better than older treatment.