评价改良 Albee 关节成形术治疗小儿化脓性关节炎所致股骨头丢失。

Department of Orthopaedics, the 1st Affiliated Hospital, Medical College of Shantou University, Guangdong 515041, China.

J Bone Joint Surg Am. 2010 Jun;92(6):1370-80. doi: 10.2106/JBJS.I.00201.

BACKGROUND

Surgical treatment options for femoral head deficiency in infants secondary to septic arthritis of the hip are varied and associated with uncertain long-term outcomes. The modified Albee arthroplasty has been considered an acceptable procedure; however, the long-term outcomes of this procedure have not been reported, to our knowledge. We evaluated the long-term outcomes of the modified Albee arthroplasty in young patients with severe sequelae of septic arthritis of the hip.

METHODS

We retrospectively studied twenty-one children (twenty-one hips) in whom Choi type-IVB sequelae of septic arthritis of the hip had been treated with a modified Albee arthroplasty and six patients with the same sequelae who had been managed with simple observation. The Trendelenburg sign, pain, the range of motion, hip function, the Harris hip score, and limb-length discrepancy were assessed clinically. Remodeling of the femoral head, hip stability, and arthritic changes in the hip were evaluated radiographically.

RESULTS

The twenty-one patients with the modified Albee arthroplasty were followed for an average of 121.2 +/- 38.6 months and had better outcomes, in terms of the Trendelenburg sign, the Harris hip score, pain, the hip range of motion, and limb-length discrepancy, than the six patients who underwent simple observation. Patients who were two years of age or younger at the time of the arthroplasty exhibited a significantly less severe limb-length discrepancy and less loss of motion than those who were older than two at the time of the surgery. Furthermore, limb-length discrepancy was positively correlated and the range of motion of the hip and the Harris hip scores were negatively correlated with the patient's age at the time of the surgery, suggesting that early surgery in patients with severe sequelae of septic arthritis of the hip is associated with a better clinical outcome.

CONCLUSIONS

The modified Albee arthroplasty is a feasible and clinically useful procedure for the treatment of severe sequelae of septic arthritis of the hip, particularly in children who are two years of age or younger.

背景

髋关节化脓性关节炎导致的婴儿股骨头发育不全的手术治疗方法多种多样，但长期疗效不确定。改良 Albee 关节成形术被认为是一种可接受的手术方法，但据我们所知，该手术的长期疗效尚未报道。我们评估了改良 Albee 关节成形术治疗髋关节化脓性关节炎严重后遗症的长期疗效。

方法

我们回顾性研究了 21 例（21 髋）采用改良 Albee 关节成形术治疗 Choi Ⅳ型 B 期髋关节化脓性关节炎后遗症的患儿和 6 例采用单纯观察治疗的同类型后遗症患儿。临床评估了 Trendelenburg 征、疼痛、关节活动度、髋关节功能、Harris 髋关节评分和肢体长度差异。影像学评估了股骨头重塑、髋关节稳定性和髋关节关节炎变化。

结果

采用改良 Albee 关节成形术的 21 例患者平均随访 121.2±38.6 个月，在 Trendelenburg 征、Harris 髋关节评分、疼痛、髋关节活动度和肢体长度差异方面的结果均优于 6 例单纯观察治疗的患者。在接受关节成形术时年龄为 2 岁或以下的患者，肢体长度差异明显较小，运动丧失也明显较少。此外，肢体长度差异与患者手术时的年龄呈正相关，髋关节活动度和 Harris 髋关节评分与手术时的年龄呈负相关，这表明髋关节化脓性关节炎严重后遗症的患者早期手术与更好的临床结果相关。