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目的比较比基尼切口与Smith-Peterson切口(S-P切口)行Salter手术治疗儿童发育性髋关节脱位(DDH)的疗效和优缺点。方法 2008年7月-2009年7月本院共收治DDH患儿45例,随机分为2组,分别使用S-P切口(27例,S-P切口组)和比基尼切口(18例,比基尼切口组)行Salter骨盆截骨手术治疗,根据股骨颈前倾角情况决定是否行股骨近端旋转截骨或旋转短缩截骨术,术后行骨盆前后位X线摄片观察临床疗效,以髋臼指数(AI)及中心边缘角(CE角)评价疗效,并比较治疗效果差异。结果术后骨盆前后位X线摄片评定手术效果,比基尼切口组CE角优良17例,欠佳1例;S-P切口组CE角优良26例,欠佳1例。用Severin标准评价CE角术后优良率,二组比较差异无统计学意义(χ2=0.1545,P>0.05)。AI均改善明显。但比基尼切口组未发现术中股外侧皮神经损伤,切口美观且隐蔽,家长易于接受,行股骨旋转截骨者股骨内固定钢板符合张力带原则,截骨处固定稳固,骨折易愈合。结论比基尼切口内行Salter骨盆截骨术与S-P切口比较治疗儿童DDH临床疗效确切,且切口安全、美观,术后对关节功能影响小。
Objective To compare the advantages and disadvantages of Salter for the treatment of children with developmental dislocation of the hip (DDH) by comparing bikini incision with Smith-Peterson incision (S-P incision). Methods From July 2008 to July 2009, 45 children with DDH were randomly divided into two groups: SP incision (27 cases, SP incision group) and bikini incision (18 cases, bikini incision group) Salter pelvic osteotomy surgery, according to the anterior femoral neck anteversion to determine whether the proximal femoral revolving osteotomy or rotation shortening osteotomy, postoperative pelvic anteroposterior X-ray observation of clinical efficacy, the acetabular index (AI ) And the center of the edge angle (CE angle) evaluation of efficacy, and to compare the differences in treatment effect. Results Postoperative pelvic anteroposterior X-ray radiography to assess the effect of surgery, bikini incision group CE angle excellent in 17 cases, 1 case of poor; S-P incision group 26 cases of excellent CE angle, poor in 1 case. The excellent and good rate of postoperative CE angle was evaluated by Severin standard. There was no significant difference between the two groups (χ2 = 0.1545, P> 0.05). AI improved significantly. However, the bikini incision group did not find intraoperative lateral femoral cutaneous nerve injury, incision beautiful and hidden, easy to accept the parents, the line femoral osteotomy femoral intertrochanteric plate in line with the principle of tension band, osteotomy fixed, fracture healing. Conclusion The biliary incision with Salter pelvic osteotomy and S-P incision compared with the treatment of children with DDH clinical curative effect, and the incision is safe, beautiful, postoperative impact on joint function is small.