Salter 骨盆截骨术的现代临床应用观点

发育性髋关节发育不良不仅仅是髋臼与股骨头对应关系的异常，同时还包括髋臼和股骨头的发育异常。为了克服行走期发育性髋关节发育不良儿童髋关节复位后仍然存在的髋关节不稳定，尤其是髋臼前外侧的发育缺陷， Robert Salter 于1961年发明了 Salter 骨盆截骨术( salter innominate osteotomy，SIO )治疗发育性髋关节发育不良。SIO 以耻骨联合为铰链，可使髋臼向前、下、外恢复覆盖，骨盆截骨处可通过骨块和克氏针固定，从而得到一个稳定复位的髋关节。1962年SIO还用于治疗Perthes病。SIO 至今已经沿用了50余年，治疗了大量的发育性髋关节发育不良病例，结合对于截骨应力、截骨方式的改良、植骨材料以及内固定等多方面的研究，SIO 在全世界多个医学中心获得了良好的短期和长期效果[1]。

Objective To summarizethe status of screening of developmental dysplasia of the hip ( DDH ) in infants and young children 0 - 36 months of age and to generate a standardized process for DDH screening in infants and young children.Methods Preliminary DDH screening was carried out by obstetricians for newborns, and by pediatricians for infants and young children 0 - 36 months inpatients in ward, and by pediatric surgeon for infants and young children 0 - 36 months of age outpatient. Secondary screening was performed by pediatric orthopedic surgeons. In addition, ultrasound or radiograph examination of bilateral hip joints was performed. Suspected cases were followed up regularly until patients were diagnosed with DDH or excluded.Results From January 2012 to December 2014, 22 396 infants and young children were screened at the First Afifliated Hospital of Zhengzhou University, Zhengzhou, China. Ultrasound examination was performed for 2669 patients, 591 of whom ( 775 hips ) with suspected and abnormal ifndings were transferred to the Department of Pediatric Orthopedics. Among the referrals, a positive Ortolani or Barlow test was observed in 61 patients ( 89 hips ). Anteroposterior hip radiography showed acetabular dysplasia in 94 cases ( 131 hips ). Finally, 76 patients ( 121 hips ) were diagnosed with DDH. Among them, 21 ( 29 hips ) were males and 55 ( 92 hips ) were females. The left side was involved in 91 hips, and the right side was involved in 30 hips. Thirteen cases ( including 3 newborns ) were 1 - 6 months old ( 1.95‰, 13 / 6676 ), 49 cases were 7 - 18 months old ( 7.09‰, 49 / 6909 ), and 14 cases were 19 - 36 months old ( 1.59‰, 14 / 8811 ). Among the 76 cases of DDH, 49 ( 64.47% ) were 7 - 18 months old. The incidence of hip dysplasia was 3.39‰ ( 76 / 22 396 ).Conclusions During the present study, we screened infants and young children 0 - 36 months old for early detection and diagnosis of DDH and generated a standardized screening process based on the actual status of patients in our district.