Fan Zhang, Cong Luo, Hang Liu, Ming Li, Jun Wu, Zujie Hu, Haoyu Li
Department of Orthopaedic Fuling central hospital of Chongqing City Chongqing, China.
Department of Orthopaedic, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
J Child Orthop. 2020 Jun 1;14(3):201-207. doi: 10.1302/1863-2548.14.190116.
Despite the early diagnosis and treatment of developmental dysplasia of the hip (DDH), some older children still need open reduction. It is usually difficult to get a satisfactory reduction particularly in patients with acetabular defect. The purpose of this study was to evaluate the short-term outcomes of acetabulum reaming and sartorius muscle pedicle iliac bone grafting in the treatment of older children with DDH and acetabular defect.
The records of 15 patients with DDH (mean age 113.9 months (sd 29); 17 hips) who were treated with the reported technique between February 2015 and January 2017 were retrospectively reviewed. All patients acquired regular clinical and radiographic follow-ups, and alterations in the acetabular index, centre-edge angle and acetabular head index were measured. Joint function and radiographic results were evaluated with McKay and Severin modified criteria, respectively.
A total of 15 patients were followed up for mean 32.4 months (sd 6.9). The percentages of excellent and good conditions were 94.1% (16/17) according to the Severin modified criteria and 88.2% (15/17) according to the McKay modified criteria. Avascular necrosis of the femoral head and redislocation only occurred in one hip. No cases of ankylosis or bone graft absorption occurred during the follow-up.
Reaming the acetabulum and sartorius muscle pedicle iliac bone grafting for repairing the acetabular defect can recover the arcuate structure by increasing the volume of the acetabulum, which is beneficial for achieving a concentric reduction. The short-term outcome was satisfactory, while the long-term results need to be further observed.
IV - retrospective study.
尽管发育性髋关节发育不良（DDH）已得到早期诊断和治疗，但一些大龄儿童仍需要切开复位。尤其是髋臼缺损的患者，通常很难获得满意的复位效果。本研究的目的是评估髋臼扩刮及缝匠肌蒂髂骨移植治疗大龄DDH合并髋臼缺损患者的短期疗效。
回顾性分析2015年2月至2017年1月间采用上述技术治疗的15例DDH患者（平均年龄113.9个月（标准差29）；17髋）的病历资料。所有患者均接受定期临床及影像学随访，测量髋臼指数、中心边缘角及髋臼头指数的变化。分别采用McKay和Severin改良标准评估关节功能及影像学结果。
共15例患者获得随访，平均随访时间32.4个月（标准差6.9）。根据Severin改良标准，优良率为94.1%（16/17）；根据McKay改良标准，优良率为88.2%（15/17）。仅1髋发生股骨头缺血性坏死及再脱位。随访期间未发生关节强直或植骨吸收病例。
髋臼扩刮及缝匠肌蒂髂骨移植修复髋臼缺损可通过增加髋臼容积恢复髋臼弓状结构，有利于实现同心圆复位。短期疗效满意，但长期结果有待进一步观察。
IV级——回顾性研究。
