经髂骨内侧壁髋臼周围旋转截骨治疗髋臼发育不良.pdf

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1、·60·中国实用医刊2014年8月第4l卷第15期ChineseJournalofPracfic~MedicineAug．2014，Vo1．41，N-l5经髂骨内侧壁髋臼周围旋转截骨治疗髋臼发育不良薛源冯香高化富张印峰【摘要】目的探讨经髂骨内侧壁髋臼周围旋转截骨术治疗髋臼发育不良的疗效。方法应用经髂骨内侧壁髋臼周围旋转截骨术治疗髋臼发育不良患者36例。取髂腹股沟切口，在髂骨内侧壁骨膜下剥离，显露髋臼底内侧壁，不要解剖髂内血管神经鞘，沿髋臼周围1．5cm用骨凿截骨，上缘平坐骨大切迹，下缘在耻骨梳及坐骨体

2、处，凿穿双层皮质，但不要凿穿外侧骨膜，使髋臼成为一游离单位，用顸棒顶压使其向前外及下方旋转，矫正Shaq~角至35。左右，恢复股骨头正常覆盖率75％以上。自髂前上棘穿入2枚斯氏针顶压在髋臼底内侧壁上。术后无需石膏固定。结果36例中31例术后随访7—82个月，平均22个月。参照Mckay评级法，疗效优2l例，良8例，差0例。结论经髂骨内侧壁髋臼周围旋转截骨治疗髋臼发育不良，方法简单有效，创伤小，且对骨盆的稳定性影响较小，内固定可靠，不需石膏固定，减轻患者痛苦及避免石膏并发症的发生。可迭到缓解患髋疼痛，避

3、免或延缓骨性关节炎的目的。【关键词】髋臼发育不良；髋臼周围旋转截骨；斯氏针顶压Periacetabularrotationalosteotomythroughthemedialwallofiliumforthetreatmentofacetabu-lardysplasiaXUEYuan，FENGXiang，GAOHua，ZHANGYin-feng．DepartmentofHematolo—gY，People’SHospitalofZaozhuang，Zaozhuang277101，China【Abst

4、ract】ObjectiveToinvestigatetheeffectofperiacetabularrotationalosteotomythroughthemedialwallofiliumonacetabulardysplasia．MethodsThirty-sixpatientswithacetabulardysplasiawereoperatedwithperiacetabularrotationalosteotomythroughmedialwallofilium．Firstly，the

5、dissec-tionwasperformedinthesubperiostealplaneofthemedialiliumviatheilioinguinalincisiontoexposethemedialwallofthebottomofacetabulum．Secondly，withoutdissectingtheinternaliliacvasculoneuralsheaths，osteotomewasusedtocompletetheosteotomyaroundtheacetabulum

6、within1．5cm．Thesupe—riorportionwzisgreatersciaticnotchandtheinferiorportionwaspectenpubisandbodyofischium．Inor—dertoisolatetheacetabulum，thetwolayercorticalbonewascutthroughandwithoutdamagingthelater—alperiosteum．Thirdly，withthehelpofbiofixrods，theaceta

7、bulumwasrotatedanterolaterallyandinferi—orlytocorrecttheSharpangleto35。andtorestorethecoveragerateoffemoralheadto75％．Twostein-mannpinswereusedtoputpressureonthemedialwallofthebottomofacetabulumthroughanteriorSU-periorspine．Postoperatively，noneoftheopera

8、tedpatientswasimmobilized．ResultsThirty—oneofthetotal36patientshad7to82months(average22months)offollowup．AccordingtoMckaycriteria，theeffectwasexcellentin21casesandgoodin8cases．ConclusionsPeriacetabularrotationalosteotomythroughth