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 was 2-20 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.
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。.
Keywords: Ilizarov hip reconstruction; adolescent; hip instability.