改良髂腹股沟入路髋臼周围截骨术治疗髋臼发育不良

摘要

目的：研究改良髂腹股沟入路在行伯尔尼髋臼周围截骨术（Bernese periacetabular osteotomy ）治疗髋臼发育不良的可行性。方法自2008年5月～2012年6月，采用改良的髂腹股沟入路行伯尔尼髋臼周围截骨术治疗15例（共17髋）因髋臼发育不良造成髋关节疼痛的患者。患者平均年龄35.6岁（16～48岁），男1例1髋，女14例16髋。测量术前、术后髋臼的CE角和AC角，记录骨关节炎的严重程度并进行随访，对髋关节进行 Harris评分。结果所有患者髋臼周围截骨术后股骨头覆盖均得到改善，CE角由术前（4．50°±4．18°）矫正为（28．80°±6．71°），AC角由术前的（26．54°±5．73°）矫正为（4．20°±5．22°）。平均随访3.5年（1～5年），17髋疼痛均减轻，骨关节炎得到一定控制，Harris评分由术前（81．21±5．45）分改善为（96．82±6．76）分，无截骨块不愈合及重要神经损伤病例。结论改良的髂腹股沟入路行伯尔尼髋臼周围截骨术治疗成人髋臼发育不良可以获得较好疗效，是一种有效、安全的手术方式。%Objective To examine the feasibility of a modified ilioinguinal approach to Bernese periacetabular osteotomy for congenital acetabular dysplasia.Methods From May 2008 to June 2012 ,15 patients (17 hips) with an average age of 35.6 years (range:16 to 48 years ,1 male and 16 females) were treated with Bernese periacetabular osteotomy with a modified ilioinguinal approach.The CE angle and AC angle were evaluated radiographically before and after the operation.Hips were evaluated with the use of osteoarthritis index and Harris score postoperatively.Results The coverage of the femoral head was enhanced after surgery in all patients.Significant improvement was seen radiographically with regard to the CE angle which changed from (4.50°±4.18°)to(28.80°±6.71°),andACanglewhichchangedfrom(26.54°±5.73°)to(4.20°±5.22°).Follow-upwas performed for an average of 3.5 years (1-5 years).Hip pain was found to be alleviated in the 17 hips and osteoarthritis was controlled after surgery.Harris score was improved from (81 .21 ± 5 .45) to (96 .82 ± 6 .76).Complications ,such as nonunion of bone osteotomy and important nerve injury ,did not occur.Conclusion The modified ilioinguinal approach to Bernese periace-tabular osteotomy can safely and effectively treat acetabular dysplasia with satisfactory outcomes achieved.