影响髋臼周围截骨术结果术前因素分析.docVIP

影响髋臼周围截骨术结果术前因素分析 　【摘要】 [目的]探讨术前因素对髋臼周围截骨术结果的影响。[方法]2002～2006年接受髋臼周围截骨术的56例髋关节发育不良患者，共56髋，平均随访2.7年。定义髋臼周围截骨术后WOMAC疼痛评分在10分(中度疼痛)以上和(或)术后Tnnis分期显示骨关节炎有进展的患者为不满意组，其余为满意组。比较满意组和不满意组之间术前疼痛和影像学表现等评估指标的差异性。[结果]56髋中，不满意组病例数为10髋。其余46髋为满意组。比较满意组和不满意组之间各术前评估指标见年龄、外侧CE角、前方CE角、臼顶倾斜角，无组间差异性，而WOMAC疼痛评分、Shentons线连续性、Tnnis分期有显著性差异。满意组术后和术前WOMAC评分有显著性差异。满意组和不满意组之间CE角和臼顶倾斜角在术后没有差异性。[结论]髋臼周围截骨术可以有效地改善髋臼覆盖情况，缓解患者疼痛症状。髋臼发育不良继发骨关节炎术前就较严重的患者，髋臼截骨术后结果不满意率较高。 【关键词】 髋关节发育不良; 骨关节炎; 髋臼周围截骨术 　　Abstract: [Objective]To investigate the effects of preoperative factors on results of periacetabular osteotomy in hip dysplasia patients. [Method]Fifty-six hips in 56 patients undergoing a periacetabular osteotomy for the treatment of hip dysplasia were included in this study. The patients would join in the unsatisfied group if the postoperative WOMAC pain score was gt;10 points or if the progressing osteoarthritis was proved by the T nnis grade. And the remaining patients would join in the satisfied group.The differences of preoperative clinical and radiographic factors between unsatisfied group and satisfied group were identified.[Result]Ten hips in the unsatisfied group had significantly more WOMAC pain score(t=3.969,Plt;0.001), more serious osteoarthritis on preoperative radiographs(demonstrated by the Tnnis grade)(x2=21.356,Plt;0.01) and more subluxation(x2=4.966,Plt;0.05) than the other 46 hips in the satisfied group.In the satisfied group,the WOMAC pain score had significant improvement postoperatively. The CE angle and the acetabular index angle had no differences between the unsatisfied group and the satisfied group postoperatively.[Conclusion]Periacetablar osteotomy for the treatment of hip dysplasia can improve the coverage of the hip and decrease the pain. The patients having more serious preoperative osteoarthritis will have worse outcome of periacetablar osteotomy. 　　Key words：hip dysplasia; osteoarthritis; periacetabular osteotomy 　　髋关节严重骨关节炎是人工全髋置换术的主要适应证之一。髋关节发育不良造成的髋关节力学负荷增大是导致继发性骨关节