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目的探讨Y形截骨术治疗儿童发育性髋内翻的疗效。方法 2008年1月-2011年10月,收治10例14髋儿童发育性髋内翻。男4例5髋,女6例9髋;年龄5～12岁,平均7.8岁。患儿均有明显跛行步态,髋部外展、内收、旋转受限。摄骨盆正位X线片,测量颈干角为46～110°,平均87°;双髋Y形软骨的Hilgenriener线与股骨上干骺端骺板线的夹角(Hilgenreiner-epiphyseal angle,HE)为36～93°,平均57°;股骨头最高点平面与股骨大粗隆顶点平面间距离(articulotrochanteric distance,ATD)为—25～6 mm,平均—3 mm。采用股骨粗隆下股骨外侧Y形截骨矫形,联合外展截骨角钢板内固定。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患儿均获随访,随访时间14～40个月,平均18个月。患儿跛行步态消失或明显减轻,髋关节外展、内收、旋转活动范围均不同程度增大。术后复查X线片示,垂直的股骨近端骺板均恢复至水平位置,患髋颈干角为130～153°,平均137°;HE角为23～35°,平均27°;ATD为3～22 mm,平均14 mm。末次随访时,根据刘建德的疗效评价标准评定,获优5髋,良8髋,可1髋;优良率达92.8%。除1例于术后30个月髋内翻畸形复发,其余患儿均无复发。结论 Y形截骨术治疗儿童发育性髋内翻具有截骨方法简便,矫形充分,术后允许早期活动的优点,可获得满意临床疗效。
Objective To investigate the curative effect of Y-shaped osteotomy on children with developmental coxa vara. Methods From January 2008 to October 2011, 10 cases of developmental hip varus were treated in 14 children. Male 4 cases of 5 hips, 6 females 9 hips; aged 5 to 12 years, mean 7.8 years. Children have obvious limp gait, hip abduction, adduction, rotation limited. The posterior pelvis orthoparasion was performed on the X-ray film. The angle of the neck was 46-110 ° with an average of 87 °. The angle between the Hilgenriener line of the double hip Y-shaped cartilage and the epiphyseal plate of the femur (Hilgenreiner-epiphyseal angle, HE) Was 36-93 ° with an average of 57 °. The mean distance between the highest femoral head plane and the femoral greater trochanter vertex was -25 ~ 6 mm and averaged -3 mm. The femoral tuberosity lateral femoral Y-shaped osteotomy correction, combined with abduction osteotomy angle plate fixation. Results Postoperative incision healed by first intention, no operative complications occurred. Children were followed up for 14 to 40 months, an average of 18 months. Children with limp gait disappeared or significantly reduced, hip abduction, adduction, rotation range of activities increased in varying degrees. Postoperative review of X-ray showed vertical proximal femur epiphyseal plate were restored to the horizontal position, with hip angle of 130 ~ 153 °, an average of 137 °; HE angle of 23 ~ 35 °, an average of 27 °; ATD 3 ~ 22 mm, an average of 14 mm. At the final follow-up, according to Liu Jiande’s evaluation criteria for efficacy, we got 5 hips, 8 hips and 1 hip, and the excellent and good rate was 92.8%. In addition to a case of 30 months after the recurrence of volar varus deformity, the remaining children were no recurrence. Conclusion Y-shaped osteotomy for the development of children with developmental choroidal varicosity with osteotomy method is simple, adequate orthosis, postoperative allow the advantages of early activities, to obtain satisfactory clinical efficacy.