摘要目的 通过对改良Colonna髋关节复位关节囊成形术病例的早期随访,探讨该手术在治疗年轻患者单侧髋关节脱位中的早期效果.方法 2011年7月至2013年2月,共有25例符合手术适应证患者(25髋)在解放军总医院第一附属医院进行改良Colonna关节囊成形手术治疗.其中男性7例,女性18例;年龄9.7 ～25.8岁,平均17.8岁;左侧12例,右侧13例;体重指数15.6～29.6 kg/m2,平均20.9 kg/m2.观察指标包括:术前术后髋关节活动度、Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、视觉模拟量表(VAS)评分,术后患者对手术效果的满意度,以及末次随访时Severin分级、T(o)nnis骨关节炎分级.对术前、术后功能评价指标进行配对t检验.将所有患者按照手术治疗时年龄分为＜16岁组(15例)和≥16岁组(10例),采用成组资料方差分析比较两组患者末次随访时的功能评价指标及患者对手术满意度.结果 患者均获得随访,随访时间12 ～ 18个月,平均13.4个月.髋关节活动度明显减小:术前平均380°,末次随访平均200°.术后9个月与术前比较,Harris髋关节评分(78 ±9比84 ±15,t=2.107,P=0.046)及WOMAC功能评分(14.8±8.4比8.6±9.6,t=-2.657,P=0.014)差异均有统计学意义.在末次随访中所有评分均有明显改善,但差异无统计学意义.末次随访时＜16岁组的VAS疼痛评分和对手术效果的满意程度明显优于≥16岁组,VAS评分分别为1.1±0.8和2.8±1.4(F=12.810,P=0.002),手术满意度分别为89±17和66±22(F=7.535,P=0.012).术后Severin分级为:Ⅰ级21髋、Ⅱ级l髋、Ⅲ级2髋、Ⅳ级2髋;术后T(o)nnis骨关节炎程度,0级5髋、1级12髋、2级7髋、3级1髋.结论 大部分青少年单侧髋脱位的患者经改良Colonna关节囊成形术治疗获得满意的复位和早期治疗效果,术后有较长康复过程,低龄组(＜16岁)治疗效果优于大龄组(≥16岁).通过严格手术适应证,精准手术操作技术与优化术后康复方案有望提高术后疗效.

abstractsObjective To discuss the early clinical results and risk factors of modified Colonna capsular arthroplasty for young patients with unilateral hip dislocation.Methods From July 2011 to February 2013,25 cases (25 hips) of modified Colonna capsular arthroplasty for unilateral hip dislocation in the 1st affiliated hospital of People's Liberation Army General hospital was collected,including 7 males,18 females; aged 9.7-25.8 years,averaging 17.8 years; left 12 cases,right 13 cases; Body mass index ranged 15.6-29.6 kg/m2,averaging 20.9 kg/m2.Clinical indexes were collected,including:range of motion (ROM) of the hip,the Harris Hip Score (HHS),West Ontario and McMaster University Osteoarthritis Index (WOMAC),visual analogue scale (VAS) score before and after surgery,along with the satisfaction score of the surgery,Severin grades,and T(o)nnis osteoarthritis grades at last follow-up.Paired t-test was applied for the indexes before and after surgery,variances components analysis was applied for the satisfaction score and the function scores at last follow-up compared in 2 groups,aging at surgery ＜ 16 years (15 cases) and ≥ 16 years (10 cases).Results All cases were followed up for 12-18 months,mean 13.4 months.The average hip ROM decreased from 380° in average pre-surgery to 200° in average at last follow-up.Indexes decreased comparing 9 months follow-up to pre-surgery,HHS(78 ± 9 vs.84 ± 15,t =2.107,P =0.046),WOMAC function score(14.8 ±8.4 vs.8.6 ±9.6,t =-2.657,P =0.014) appeared statistically difference.Indexes increased at the last follow-up,showing no statistically difference.VAS and the satisfaction score were much better in patients ＜ 16 years group compared with ≥16 years group at last follow-up.VAS was 1.1 ±0.8 compared with 2.8 ± 1.4(F =12.810,P =0.002),whereas the satisfaction score was 89 ± 17 compared with 66 ± 22 (F =7.535,P =0.012).The last radiological follow-up resulted that,Severin grade Ⅰ 21 cases,grade Ⅱ 1 case,grade Ⅲ 2 cases,grade Ⅳ 2 cases,and the T(o)nnis osteoarthritis grade 0 with 5 cases,grade 1 with 12 cases,grade 2 with 7 cases,grade 3 with 1 case.Conclusions In this early follow up,the majority of patients who underwent modified Colonna capsular arthroplasty for their unilateral hip dislocation would obtained satisfactory results,but with long term recovery,and the younger group (＜ 16 years) with better clinical results than the elder group (≥ 16 years).With strict indications,exacted surgical techniques and optimized rehabilitation,the modified Colonna arthroplasty would have better clinical results.