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经转子旋转内翻截骨术后发育性髋关节的演变(作者译)

[The development of the dysplastic hip-joint following intertrochanteric rotating varus-osteotomy (author's transl)].

作者信息

Reichelt A, Hansen L

出版信息

Z Orthop Ihre Grenzgeb. 1975 Dec;113(6):995-1004.

PMID:1216997
Abstract

Evaluation of radiographs of 267 children with 465 intertrochanteric rotating varus osteotomies, carried out between the ages of 15 months and 14 1/2 years. The period of follow-up varied between 2 and 15 1/4 years. 1. The CCD angle on the last radiograph was normal in 77%, once more in values in 16.2%, coxa vara in 7%. 2. The AT angle was about normal only in 58.3% (0-20 degrees); it relapsed in 8.4% (over 35 degrees); in 8.8% a corrected angle did not return after retrorotation, particularly on the left. 3. The Ac angle was normal in 63.3%. 4. The CE angle corresponded to the norm in 59.1%. 5. Good late results (normal angles and shape of head) occur only in 20%. If one omits the AT condition, they rise to 40%. 6. The main causes of return of valgus appear to be: too early operation before the fifth year, mainly when disregarding the dysplastic acetabular roof, insufficient correction of the CCD angle of over 115 degrees, and technical faults. For physiologic weightbearing by the acetabular roof an AT angle of 10 appears necessary. 7. When dysplasia of the acetabular roof is present, the polyaxial correction of the proximal end of femur must be combined with acetabuloplasty or pelvic osteotomy.

摘要

对267名儿童的465例转子间旋转内翻截骨术的X线片进行评估,手术年龄在15个月至14岁半之间。随访时间为2至15年零3个月。1. 最后一张X线片上的颈干角正常者占77%,再发者占16.2%,髋内翻者占7%。2. 颈干角仅在58.3%(0 - 20度)时大致正常;复发者占8.4%(超过35度);8.8%的病例在旋转后矫正角度未恢复,尤其是左侧。3. 髋臼角正常者占63.3%。4. 中心边缘角符合正常者占59.1%。5. 良好的后期结果(角度正常且股骨头形状正常)仅占20%。若不考虑颈干角情况,则升至40%。6. 外翻复发的主要原因似乎是:5岁前手术过早,尤其是忽视发育不良的髋臼顶时;颈干角矫正不足超过115度;以及技术失误。为使髋臼顶进行生理性负重,颈干角似乎需要10度。7. 当存在髋臼顶发育不良时,股骨近端的多轴矫正必须与髋臼成形术或骨盆截骨术相结合。

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