摘要
目的探讨髋关节镜手术与髋臼周围截骨术(periacetabular osteotomy,PAO)治疗临界型发育性髋关节发育不良(borderline developmental dysplasia of the hip,BDDH)的临床疗效。方法回顾性收集2016年7月至2020年6月采用髋关节镜手术或PAO治疗的57例BDDH患者。髋关节镜手术(hip arthroscopy,HA)组32例,男6例、女26例,年龄(34.5±6.4)岁(范围19~47岁);PAO组25例,男5例、女20例,年龄(37.2±6.9)岁(范围21~50岁)。收集并测量患者术前、末次随访时影像学指标,包括外侧中心边缘角(lateral center edge angle,LCEA)、前方中心边缘角(anterior center edge angle,ACEA),外凸指数、Tönnis角、股骨颈前倾角及Tönnis分级。术前、术后6个月、12个月及末次随访时评估两组患者术后髋关节结果评分日常生活能力量表(hip outcome score activity of daily living scale,HOS-ADL)、改良Harris髋关节功能评分(modified Harris hip score,mHSS)、非骨关节炎髋关节评分(non-arthritic hip score,NAHS)。结果HA组随访时间为(54.2±8.2)个月,PAO组为(55.5±9.4)个月。两组术前LCEA、ACEA、外凸指数、Tönnis角、股骨颈前倾角及Tönnis分级的组间差异均无统计学意义(P>0.05)。HA组术前α角为60.8°±5.8°,与PAO组53.0°±5.9°的差异有统计学意义(t=5.07,P<0.001)。HA组末次随访LCEA、ACEA、外凸指数、Tönnis角、α角分别为20.0°±2.1°、20.0°±2.6°、30.6%±2.3%、10.8°±1.6°、39.8°±5.4°,较术前改善(P<0.05),Tönnis分级与术前相比差异无统计学意义(χ^(2)=5.72,P=0.057);PAO组术后LCEA、ACEA、外凸指数、Tönnis角分别为33.0°±3.0°、33.3°±4.0°、15.0%±4.0%、2.8°±1.7°,较术前改善(P<0.05),末次随访α角和Tönnis分级与术前差异无统计学意义(P>0.05);两组末次随访LCEA、ACEA、外凸指数、Tönnis角、α角的差异均有统计学意义(P<0.05);Tönnis分级的差异无统计学意义(χ^(2)=3.02,P=0.996)。两组术前mHHS评分、NAHS评分和HOS-ADL评分差异无统计学意义(P>0.05);术后随访两组评分均较术前提高,差异有统计学意义(P<0.05);HA组术后6、12个月三个评分均高于PAO组,差异有统计学意义(P<0.05),但两组末次随访时的差异均无统计学意义(P>0.05)。结论HA或PAO治疗BDDH均能获得较好的早中期临床疗效,HA早期临床疗效优于PAO,中期临床疗效二者相似;PAO可改善BDDH髋臼影像学指标(除α角外),而HA仅可改善α角,但二者均能有效延缓髋关节骨关节炎的影像学进展。
ObjectiveTo explore the clinical efficacy of hip arthroscopy(HA)and periacetabular osteotomy(PAO)in the treatment of borderline developmental dysplasia of the hip(BDDH).MethodsThe clinical data of 57 patients with BDDH treated with HA or PAO from July 2016 to June 2020 were retrospectively studied.According to surgical methods,they were divided into HA group and PAO group.There were 32 patients(6 males and 26 females)in HA group,with an average age of 34.5±6.4 years,ranging from 19 to 47 years.There were 25 patients(5 males and 20 females)in the PAO group,with an average age of 37.2±6.9 years,ranging from^(2)1 to 50 years.Patients were followed up till May 2023.Imaging data of patients before the surgery and during follow-up were collected including lateral center edge angle(LCEA),anterior center edge angle(ACEA),extrusion index,Tönnis angle,femoral neck anteversion angle,and Tönnis grade.The modified Harris hip score(mHSS),non-arthritic hip score(NAHS)and hip outcome score activity of daily living scale(HOS-ADL)were evaluated at 6 months,12 months and the final follow-up.ResultsAll patients were followed up for an average of 54.2±8.2 months in HA group and 55.5±9.4 months in PAO group separately.Before surgery,there were no significant differences in LCEA,ACEA,Tönnis angle,extrusion index,femoral neck anteversion angle and Tönnis grade between the two groups(P>0.05).αangle of HA was 60.8°±5.8°,which was significant different fromαangle of PAO 53.0°±5.9°(t=5.07,P<0.001).At the final follow-up,in HA group,LCEA,ACEA,Tönnis angle,extrusion index were 20.0°±2.1°,20.0°±2.6°,30.6%±2.3%,10.8°±1.6°,39.8°±5.4,which were all significantly different from pre-operation data(P<0.05).While there was no significant difference between pre-and post-operation in Tönnis grade(χ^(2)=5.72,P=0.057).In PAO group,LCEA,ACEA,Tönnis angle,extrusion index were 33.0°±3.0°,33.3°±4.0°,15.0%±4.0%,2.8°±1.7°which were all significantly different from pre-operation data(P<0.05).While there were no significant differences between pre-and post-operation inαangle and Tonnis grade(P>0.05).Between HA group and PAO group,there were significant differences in LCEA,ACEA,Tönnis angle,extrusion index andαangle(P<0.05),while no significant difference was found in Tönnis grade(χ^(2)=3.024,P=0.996).There were no significant differences between the two groups in preoperative mHHS,NAHS and HOS-ADL(P>0.05).At 6 months,12 months and the final follow-up after operation,the mHHS,NAHS and HOS-ADL were significantly improved compared to pre-operation data(P<0.05).At 6 months and 12 months after operation,the three hip function scores in HA group were significantly better than those in PAO group(P<0.05).At the final follow-up,there was no significant difference in three hip scores between the HA group and the PAO group(P>0.05).ConclusionBoth HA and PAO can achieve good short-and mid-term clinical efficacy in the treatment of BDDH.Specifically,HA is superior to PAO in the early clinical efficacy,and the mid-term clinical efficacy is similar.PAO is able to improve the acetabular radiographic parameters of BDDH(exceptαangle)while HA can only improveαangle.However,they all can effectively delay the imaging progression of hip osteoarthritis.
作者
杨硕瑶
杨顺杰
王令成
游茗柯
周凯
陈曦
陈刚
Yang Shuoyao;Yang shunjie;Wang Lingcheng;You Mingke;Zhou Kai;Chen Xi;Chen Gang(Sports Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Orthopedics and Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第23期1562-1572,共11页
Chinese Journal of Orthopaedics
