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2至8岁儿童不使用骨移植的经皮无名骨盆截骨术用于股骨头覆盖。

Percutaneous innominate pelvic osteotomy without the use of bone graft for femoral head coverage in children 2-8 years of age.

作者信息

Sanchez Mesa Pedro Antonio, Yamhure Fernando Helo

机构信息

Unit of Orthopaedic Pediatric Surgery, Department of Traumatology and Orthopaedic Surgery, Clinic of Niño Jorge Bejarano E.S.E, Bogotá DC, Colombia.

出版信息

J Pediatr Orthop B. 2010 May;19(3):256-63. doi: 10.1097/BPB.0b013e328331c3c3.

Abstract

Percutaneous innominate pelvic osteotomy without the use of bone graft as treatment for hip diseases is proposed as another tool to handle this pathology, which occurs frequently in our area, without changing postural correction at the level of the pelvis by secondary transiliac lengthening through an unilateral iliac bone graft at the lower extremity. This technique was developed by biomechanical studies in corpses and was later performed on children. This was a prospective, multicentric, longitudinal study of a case series in children between 2 and 8 years of age with developmental hip dysplasia, Legg-Calve-Perthes disease, aseptic or avascular necrosis, congenital or acquired lesions of the femoral head having obtained previous consent from the parents. In 121 patients with increases in femoral head coverage in a concentric hip joint, the average follow-up period was 4.1 years (range 6 months to 5 years). The vertical-center-anterior angle of Lequesne and the center-edge angle of Wiberg, both of which showed significant improvement in the coverage of the femoral head with an average of acetabular presurgical index of 38.2 degrees (P=0.002) and a postsurgical average of 19.8 degrees (P=0.003), angles of lateral uncovering of the femoral head of 12.3 degrees (P=0.0019) and a postsurgical angle of 23.2 degrees (P=0.004). The registered complications were 2.7% (P=0.047). The results offer many advantages over the current treatments on handling congenital diseases or acquired diseases of the hip and can indicate an alternative to the other methods of treatment which is possibly less aggressive and with a better future for the patient.

摘要

经皮无名骨盆截骨术不使用骨移植作为治疗髋部疾病的方法被提议作为处理这种病理情况的另一种手段,这种病理情况在我们地区经常发生,无需通过下肢单侧髂骨移植进行继发髂骨延长来改变骨盆水平的姿势矫正。该技术是通过对尸体的生物力学研究开发的,后来应用于儿童。这是一项对2至8岁患有发育性髋关节发育不良、Legg-Calve-Perthes病、无菌性或缺血性坏死、先天性或后天性股骨头病变的儿童病例系列进行的前瞻性、多中心、纵向研究,已获得家长的事先同意。在121例髋关节同心且股骨头覆盖增加的患者中,平均随访期为4.1年(范围6个月至5年)。Lequesne的垂直中心前角和Wiberg的中心边缘角,两者在股骨头覆盖方面均有显著改善,术前髋臼平均指数为38.2度(P = 0.002),术后平均为19.8度(P = 0.003),股骨头外侧未覆盖角为12.3度(P = 0.0019),术后角度为23.2度(P = 0.004)。记录的并发症为2.7%(P = 0.047)。与目前治疗先天性或后天性髋部疾病的方法相比,这些结果具有许多优势,并且可以为其他治疗方法提供一种替代方案,这种替代方案可能侵袭性较小,对患者的未来更有利。

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