【摘要】 目的探讨改良Ilizarov髋重建术治疗青年髋关节疾患的临床疗效。方法回顾性分析2010年1月—2018年3月采用改良Ilizarov髋重建术治疗的13例青年髋关节疾病患者临床资料。其中男2例,女11例;年龄14～34岁,平均24.2岁。脊柱裂后遗髋部发育不良伴脱位1例,髋关节化脓性关节炎后遗髋发育不良3例,发育性髋关节发育不良(developmental dysplasia of the hip,DDH)伴股骨头坏死拒绝行髋关节置换2例,青年发育性髋关节脱位拒绝行髋关节置换6例,痉挛型脑瘫致双髋发育不良伴脱位1例。病程2～20年,平均8.5年。术前Trendelenburg征阳性12例,阴性1例。术前髋关节Harris评分为(53.5±8.9)分,双下肢不等长为(46.08±15.73)mm。术后行髋关节Harris评分,并根据患者自行打分评价疗效满意度。结果 13例患者术后均获随访,随访时间1～5年,平均2.6年。5例患者出现术后针道感染,经换药后感染控制;7例出现膝关节活动受限,经膝关节功能锻炼后改善。术后1年患者Harris评分为(84.5±6.1)分,较术前显著改善(t=-10.538,P=0.000);根据Harris评分评价疗效,获优4例、良5例、可4例,优良率69.2%。双下肢不等长为(15.38±7.27)mm,较术前显著改善(t=11.826,P=0.000)。末次随访时患者疗效满意度评分为80%～95%,平均88%。结论改良Ilizarov髋重建术可应用于治疗不适合或拒绝行人工髋关节置换术的青年髋关节疾病患者,其疗效可靠,在重建髋关节以及改善患肢跛行、纠正肢体短缩等方面具有独特优势。更多还原

【Abstract】 Objective To evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability. Methods The clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females,aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip(DDH)accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case.The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was(46.08±15.73) mm.Postoperative Harris hip score and patients’ satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness. Results All 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation,and the patient’s hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one(t=-10.538, P=0.000).According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was(15.38±7.27) mm, which was significantly better than that before operation(t=11.826, P=0.000). At last follow-up, the patients’ satisfaction score was 80%-95%, with an average of 88%. Conclusion Modified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.更多还原