摘要目的:通过CT扫描三维重建模拟手术计划并预判治疗效果，分析骨盆三联截骨术治疗大龄儿童发育性髋关节发育不良（developmental dysplasia of the hip，DDH）的疗效。方法:回顾分析2014年7月至2017年6月采用Bernese骨盆三联截骨术治疗的大龄儿童DDH病例共12例（19髋），其中男5例（7髋），女7例（12髋）；患儿年龄（11.14±1.98）岁（范围：8岁~13.33岁）；12例中左侧4例，右侧1例，双侧7例。根据Tonnis分型，Ⅰ型8髋，Ⅱ型11髋；6髋0.20≤ Reimers指数（Reimers’s indexes，RI）<0.33，为髋臼发育不良，13髋0.33≤ RI<1为半脱位。患儿术前均行骨盆-双股骨全长CT扫描及三维重建，并进行模拟手术、制定手术计划，根据模拟手术所预期达到的矫形效果应用Bernese骨盆三联截骨术，并同期行股骨近端内翻去旋转截骨术。比较手术前后Sharp角、中心边缘角（center-edge angle，CEA）、RI和骶棘韧带长度的变化；应用改良Severin分类评价术后影像学效果，应用改良McKay分级评价肢体功能恢复情况。结果:12例（19髋）均顺利完成手术，手术时间（357±33）min（范围：290~410 min）；术中出血量（784±112）ml（范围：550~1 000 ml）。12例随访时间（34.84±8.39）个月（范围：16~48个月）。19髋的Sharp角由术前55°±3°改善至末次随访的36°±3°，同时CEA由-8°±14°改善至末次随访的22°±3°，Reimers指数由0.50±0.17改善至末次随访0.14±0.03，骶棘韧带模拟长度由（48.40±10.00）mm减小至术后的（41.60±10.47）mm，差异均有统计学意义（ P<0.05）。术前19髋中的12髋Shenton线不连续，随访时均恢复连续性。根据改良Severin分类，优12髋、良4髋、可3髋，优良率84%。根据改良McKay分级，优12髋、良6髋、可1髋，优良率95%。随访时2髋存在坐骨骨不连，2例患儿存在<2 ㎝的双下肢不等长。所有患儿术后均未出现股骨头缺血坏死、感染、断钉和神经血管损伤等并发症。 结论:Bernese骨盆三联截骨术治疗大龄儿童DDH短期效果良好，在CT扫描三维重建模拟手术的辅助下可以更为精确地判断手术指征、量化操作细节并直观判断治疗效果，值得临床推广应用。

abstractsObjective:To predict the therapeutic effect by 3D CT simulating osteotomy and to study the outcome of Bernese triple osteotomy for developmental dysplasia of the hip (DDH) in elder children (≥ 8 years).Methods:19 involved hips in12 elder Children with DDH treated with Bernese triple osteotomy from July 2014 to June 2017 were analyzed retrospectively. There were 7 involved hips in 5 boys and 12 involved hips in 7 girls with an average age of 11.14±1.98 years (8-13.33 years) at operation. 4 children were involved in left side, 1 child in right side and 7 children in both sides. 8 hips were classified in type I and 11 hips in type II as Tonnis classification. 6 hips were acetabular dysplasia with Reimers's indexes between 0.20 and 0.33 and 13 hips were subluxation with Reimers's indexes between 0.33 and 1. All the children were detected with DDH for the first time with no basic diseases and there was no previous treatment adopted. A simulating osteotomy by 3D CT of pelvis-femurs was given to each of the children pre-operation and Bernese triple osteotomy with varus derotation osteotomy in proximal femoral was applied simultaneously. The changes of Sharp angles, center edge angles, Reimers's indexes and lengths of sacrospinous ligaments were compared and P<0.05 was considered as statistical significance in the differences. Radiological results and the improvements of limbs' functions were evaluated at the latest follow-up. Results:12 children with 19 involved hips were followed up successfully with an average period of 2 years and 11months (1 year 4 months-4 years). Sharp angles were improved from 55°±3° to 36°±3°, CEAs were improved from -8°±14° to 22°±3°, Reimers's indexes were improved from 0.50±0.17 to 0.14±0.03 and lengths of sacrospinous ligaments decreased from 48.40±10.00 mm to 41.60±10.47 mm with statistical significance in the differences (all P<0.05). Disrupted Shenton lines in 12 hips pre-operation turned to be continuous post-operation. 12 hips as excellent, 4 hips as good and 3 hips as moderate with the excellent-good rate of 84% were seen as modified Severin classification. 12 hips as excellent, 6 hips as good and 1 hip as moderate with the excellent-good rate of 95% were seen as modified McKay classification. Nonunions of ischia were seen in 2 hips and limbs lengths discrepancies <2 cm were seen in 2 children. No avascular necrosis, infection, break of screw or injury of vessel and nerve was seen in all children. Conclusion:More precise indication, more meticulous operation and more intuitive outcome could be actualized assisted with 3D CT. The short-term effect of Bernese triple osteotomy for DDH in elder children is really significant and should be popularized in clinical.