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目的介绍一种可用于治疗发育性髋关节发育不良(developmental dysplasia of thehip,DDH)的Le Coeur骨盆三联截骨术。方法本组9人10髋,平均手术年龄8岁7个月(6岁5个月~12岁11个月)。手术由股骨近端的短缩、内翻或/和旋转截骨与骨盆三联截骨两个部分组成。骨盆截骨经二个切口完成:内收肌入路截断耻骨上下支,髋前外侧入路截开髂骨;将耻骨上下支向后、内推移并使断端重叠,将截开的髂骨远端向下翻压、向前旋转;自体股骨干骨块或异体骨块嵌入髂骨截面作支撑,2~3枚克氏钢针固定;术后髋人字形模具固定6~8周。结果7人有保守复位史,3人有手术复位史。手术后及短期随访的X线片上的髋臼指数(acetabular index,AI)或Sharp角,Wiberg中心边缘角(center edge angle,CE),髋臼股骨头指数(acetabular-head-index,AHI)均有明显改善,闭孔的形态大小可基本恢复对称。结论Le Coeur骨盆三联截骨术操作简单,风险小,能使股骨头获得良好的覆盖,适合于大龄儿童的髋臼发育不良或半脱位。
Objective To introduce a Le Coeur pelvis triple osteotomy for the treatment of developmental dysplasia of thehip (DDH). Methods The group of 9 patients with 10 hips, the average operative age of 8 years and 7 months (6 years 5 months to 12 years 11 months). Surgery by the proximal femoral shortening, varus and / or revolving osteotomy and pelvis triple osteotomy composed of two parts. Pelvic osteotomy by two incisions to complete: Adductor approach to cut off the suprapubic branch, hip anterolateral approach to cut off the ilium; the pubic up and down the support, the shift and make ends overlap, the cut off the ilium The distal end of the pressure down, rotate forward; autologous femoral shaft or allograft embedded iliac cross-section for support, 2 to 3 Kirschner wire fixation; Hip Hip shape after surgery for 6 to 8 weeks. Results 7 patients had a history of conservative reset, 3 patients had a history of surgical reduction. The acetabular index (AI) or Sharp angle, the center edge angle (CE) and the acetabular-head-index (AHI) of the X-ray films after operation and short- There is a clear improvement in the size of closed-cell morphology can be basically restored symmetry. Conclusion The Le Coeur pelvis triple osteotomy is simple, low risk and can achieve good coverage of the femoral head. It is suitable for the development of acetabular dysplasia or subluxation in older children.