【作者】 张腾；

【导师】 闫新峰；

【作者基本信息】 山东大学 ， 外科学（骨外科）（专业学位）， 2021， 硕士

【摘要】 目的探讨分析伯尔尼髋臼周围截骨术(Bernese periacetabular osteotomy,PAO)后髋臼前倾角对手术效果的影响。资料与方法对2004年12月至2018年10月于山东第一医科大学第一附属医院骨关节科所有因发育性髋关节发育不良(Developmentaldysplasiaofthehip,DDH)行伯尔尼髋臼周围截骨术,并至少获随访1年以上的50例(54髋)DDH患者的临床资料,进行回顾性研究。通过测量髋关节CT得到患者手术前后髋臼前倾角(Acetabularanteversion,AA)的变化,应用ROC曲线评估术后髋臼前倾角对术后Harris评分的影响。根据ROC曲线上术后髋臼前倾角的截断值将患者分组,行样本一致性检验后,比较不同分组间患者疼痛、跛行、Harris评分、骨关节炎进展等方面的数据变化。结果本研究中,患者平均随访5.37±3.66年,90.75%的患者对手术效果满意。髋臼前倾角纠正到术后的17°(15°,19°),末次随访时,Harris评分为93.62±4.03,Harris疼痛评分为39.35±3.33,iHOT-12评分为73(65.75,75),均较术前显著升高,有统计学意义(P<0.01,P<0.01,P=0.127)。术后并发症包括:术后疼痛患者2例,术后跛行患者2例,4例患者出现骨关节炎进展,3例患者术后耻骨支骨不连,4例患者出现股外侧皮神经损伤。根据术后Harris评分(HHS)结果将其分为一般(≤86分)和优秀(>86分)两个临床类别构建ROC曲线,术后Harris评分类别作为结局变量,髋臼前倾角作为状态变量。曲线下面积为0.831,二者之间存在显著相关性。根据Youden指数找到术后髋臼前倾角的截断值,分别为AA16.5°、AA12°,以此我们将患髋分为三组,分别为AA<12°组,AA12°-16.5°组,A>16.5°组。其中,AA<12°组 3 髋,AA 12°-16.5°组 21 髋,AA>16.5°组 30髋。术后对三个组Harris评分、Harris疼痛评分、iHOT-12评分进行组间比较,结果示三组患者Harris评分有显著统计学差异,(F=3.987,P=0.025)。Harris评分组间两两比较结果示,AA<12°组术后Harris评分明显低于AA>16.5°组及AA 12°-16.5°组,差异有统计学意义(P=0.009,P=0.039)。结论对于成人DDH患者,伯尔尼髋臼周围截骨术可以获得令人满意的疗效。PAO术后髋臼前倾角<12°时手术效果不理想。更多还原

【Abstract】 Objective To investigate the beneficial effect of Acetabular anteversion(AA)correction on Harris score after Bernese periacetabular osteotomy(PAO)on the surgical outcomes.Methods This is a retrospectively study include 54 developmental dysplasia of the hip(DDH)patients,all of these individuals were collected from December 2004 to October 2018 in the arthroplasty department in the First Affiliated Hospital Of Shandong First Medical University.The changes of AA before and after the operation were measured with CT of the hip joint,and the influence of postoperative Acetabular anteversion on postoperative Harris score was evaluated using ROC curve.Patients were divided in three groups by the truncated value of postoperative Acetabular anteversion on the ROC curve.The pain intensity,claudication,Harris score,and progression of osteoarthritis among different groups were compared.Results The followed-up period was 5.37±3.66 years,90.75%of the patients were satisfied with the surgical effect.Post-OP AA was 17°(15°,19°).At the end of the follow-up,the Harris score was 93.62±4.03,the Harris pain score was 39.35±3.33,and the iHOT-12 score was 73(65.75,75),two of them were significantly higher than those before surgery(P<0.01,P<0.01,P=0.127).Postoperative complications including postoperative pain(in 2 patients),postoperative claudication(in 2 patients),progression of osteoarthritis(in 4 patients),postoperative pubic ramus nonunion(in 3 patients),and lateral femoral cutaneous nerve injury(in 4 patients)were observed.Two groups were divided according to the results of postoperative Harris score(HHS):average group(≤86 points)and excellent group(>86 points)to construct ROC curves.According to Youden index,the trap-off values of postoperative Acetabular anteversion were found,which were AA16.5° and AA12°respectively.The affected hips were then divided into three groups:AA<12° group(3 individuals),AA12°-16.5° group(21 individuals),AA>16.5 °(30 patients).The Harris score of AA<12° group was significantly lower than AA>16.5°group and AA12°-16.5° group,the difference was statistically significant(P<0.05).Conclusion In adult patients with DDH,Bernese periacetabular osteotomy can help DDH patients in a better Harris score.However,Acetabular anteversion<12°would decline its beneficial effect.更多还原