摘要
目的探讨股骨近端截骨术(proximal femoral osteotomy,PFO)治疗儿童单侧发育性髋关节发育不良(developmental dysplasia of the hip,DDH)术后发生肢体过度生长的临床特点。方法回顾性分析2017年6月至2021年6月于西安市红会医院行PFO的36例单侧DDH患儿资料,男4例、女32例,年龄(4.23±3.15)岁(范围2~12岁),左侧28例、右侧8例;根据国际髋关节发育不良学会(International Hip Dysplasia Institute,IHDI)分型,Ⅰ型2例、Ⅱ型9例、Ⅲ型16例、Ⅳ型9例。于X线及髋关节CT三维重建片上测量股骨长度、股骨颈前倾角、股骨颈干角、髋臼指数(acetabular index,AI)、中心边缘角(center-edge angle,CEA)、股骨头中心距离差(center-head distance discrepancy,CHDD)、股骨近端截骨参数(内翻角度、短缩长度及去旋转角度)。比较肢体过度生长≥1 cm组与<1 cm组的术前影像学参数及截骨参数差异,分析肢体过度生长的规律和特点。结果14例肢体过度生长程度≥1 cm组年龄为(2.49±1.03)岁,22例<1 cm组年龄为(5.13±3.47)岁,两组年龄的差异有统计学意义(t=-2.757,P<0.001)。术后发生肢体过度生长且程度较重病例主要集中分布于2~4岁区间,2~4岁过度生长程度为(11.08±6.17)mm,>4~<6岁为(5.08±0.19)mm,≥6岁为(2.44±4.50)mm,差异有统计学意义(F=5.436,P=0.031);发生肢体过度生长患儿中年龄2~4岁的占比最高(56%,20/36)。患儿术后3个月开始出现肢体过度生长现象;术后6~18个月肢体过度生长程度与随访时间呈均匀线性关系[r=0.78,95%CI(0.62,0.88),P<0.001];术后18~24个月开始进入平台期,患肢过度生长程度与随访时间无相关性[r=-0.15,95%CI(-0.75,0.57),P=0.710]。术后3、6、12、18、24个月患侧CEA、CHDD的差异有统计学意义(P<0.05),患侧AI的差异无统计学意义(P>0.05)。结论2~4岁患儿进行PFO术后肢体过度生长发生率更高、过度生长程度更重;肢体过度生长快速进展期为术后6~18个月,术后18个月后进入稳定期。CEA及CHDD是评估DDH相关肢体过度生长干预效果的关键指标。
Objective To investigate the clinical characteristics of limb overgrowth following proximal femoral osteotomy(PFO)for unilateral developmental dysplasia of the hip(DDH)in children.MethodsA retrospective analysis was conducted on 36 children with unilateral DDH who underwent PFO at Xi'an Honghui Hospital from June 2017 to June 2021.The cohort included 4 males and 32 females,with a mean age of 4.23±3.15 years(range:2-12 years),comprising 28 left-sided and 8 right-sided cases.According to the International Hip Dysplasia Institute(IHDI)classification,there were 2 type I,9 type II,16 type III,and 9 type IV cases.Radiographic parameters[femoral length,femoral neck anteversion angle,neck-shaft angle,acetabular index(AI),center-edge angle(CEA),center-head distance discrepancy(CHDD)]and PFO parameters(varus angle,shortening length,derotation angle)were measured on X-ray and 3D CT reconstructions.Comparisons were made between the overgrowth≥1 cm group(n=14)and<1 cm group(n=22)to analyze risk factors and patterns.ResultsThe overgrowth≥1 cm group had significantly younger patients(2.49±1.03 years vs.5.13±3.47 years,t=-2.757,P<0.001).Overgrowth magnitude varied significantly across age subgroups:11.08±6.17 mm in the 2-4 years group,5.08±0.19 mm in the>4-<6 years group,and 2.44±4.50 mm in the≥6 years group(F=5.436,P=0.031).The highest incidence of overgrowth occurred in the 2-4 years subgroup(56%,20/36).Limb overgrowth initiated at 3 months postoperatively,exhibited a linear correlation with follow-up duration during 6-18 months[r=0.78,95%CI(0.62,0.88),P<0.001)],and plateaued after 18 months[r=-0.15,95%CI(-0.75,0.57),P=0.710].Postoperative CEA and CHDD showed significant improvements(P<0.05),while AI remained unchanged(P>0.05).ConclusionsChildren aged 2-4 years exhibit higher incidence and severity of post-PFO limb overgrowth.The rapid progression phase occurs within 6-18 months postoperatively,stabilizing thereafter.CEA and CHDD serve as critical indicators for evaluating intervention efficacy in DDH-related overgrowth.
作者
陆清达
刘趁心
王欢
杨亚婷
王家驹
郝雪
程朋真
颉强
Lu Qingda;Liu Chenxin;Wang Huan;Yang Yating;Wang Jiaju;Hao Xue;Cheng Pengzhen;Jie Qiang(Honghui Hospital Affiliated to Xi'an Jiaotong University,Pediatric Orthopedic Hospital,Xi'an 710054,China;Medical College of Yan'an University,Yan'an 716000,China)
出处
《中华骨科杂志》
北大核心
2025年第10期613-620,共8页
Chinese Journal of Orthopaedics
基金
国家自然科学基金面上项目(82272442)
陕西省卫生健康科研创新能力提升计划平台建设项目(2024PT-12)
中央高水平医院临床科研业务费资助(2022-PUMCH-D-004)。
