发育性髋关节发育不良术中截骨对术后患侧膝关节外翻的疗效

Effect of in Traoperative Osteotomy on Postoperative Valgus of Affected Knee Joint in Developmental Hip Dysplasia

摘要: 目的：观察发育性髋关节发育不良Hartofilakids III型患者，在行患侧人工关节置换术后出现患侧膝关节病理改变的特点，方法：将新疆医科大学第一附属医院关节外科近10年收治的发育性髋关节发育不良患者资料进行回顾随访分析，从中选择出发育性髋关节发育不良Hartofilakids III型患者资料，一共89髋关节发育不良Hartofilakids III型例患者参与研究，患者性别比例为男：女 ≈ 1:5，年龄范围在17~64岁，其中术中行截骨的患者73例，未行截骨患者16例；行髂胫束松解患者13例，未行髂胫束松解患者76例。与患者取得联系后指导患者在站立的状态下，拍摄双下肢全长X线片，根据检查结果测得患者股胫角，同时取得患者术前拍摄双下肢X线，其中有31例患者术后有膝外翻现象，对比术前双下肢X线股胫角后，其中术前无膝外翻但术后发生膝外翻的患者有21例，同时以是否截骨与是否髂胫束松解为变量分析患者术前及术后股胫角及髋膝关节评分变化。结论：发育性髋关节发育不良Hartofilakids III型患者，行人工髋关节置换术后，会导致患者患侧膝关节出现外翻畸形，患侧膝关节评分下降。截骨与髂胫束松解对患者术前术后髋膝关节评分影响无明显差异，对患侧膝关节术前术后股胫角的减小有显著差异。

Abstract: Objective: To observe the pathological changes of the affected knee joint in patients with develop-mental dysplasia of the hip (DDH) Hartofilakids I type III after artificial joint replacement. Materials and Methods: The data of patients with developmental dysplasia of the hip treated in the Depart-ment of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University in the past 10 years were retrospectively analyzed, from which the data of patients with developmental dysplasia of the hip type Hartofilakids III were selected. A total of 89 patients with developmental dysplasia of the hip type Hartofilakids III were involved in the study. The gender ratio of the patients was male:female ≈ 1:5, and the age ranged from 17 to 64 years. Among them, 73 patients underwent osteotomy and 16 patients did not undergo osteotomy. 13 patients underwent iliotibial band re-lease and 76 patients did not. After getting in touch with the patient, the patient was guided to take the full-length X-ray film of both lower limbs in a standing state, and the femoral tibial Angle of the patient was measured according to the examination results. At the same time, the preoperative X-ray film of the lower limbs of the patient was obtained. Among them, 31 patients had knee valgus after operation. At the same time, the preoperative and postoperative scores of femoro-tibial Angle and hip and knee joint of patients were analyzed with or without osteotomy and iliotibial band re-lease as variables. Results: In patients with developmental hip dysplasia Hartofilakids I type III, ar-tificial hip replacement may result in valgus deformity of the affected knee joint and decreased knee joint score. There was no significant difference between osteotomy and iliotibial band release on hip and knee scores before and after surgery, but there was a significant difference in the reduc-tion of femoro-tibial Angle before and after surgery.