关键词: 髋臼发育不良；髋臼周围截骨术；入路方式；创伤应激；下肢力线；影像学；髋关节功能

Abstract: Objective To investigate the effects of different approaches of periacetabular osteotomy (PAO) on traumatic stress,lower limb strength and prognosis of acetabular dysplasia (DDH).Methods Ninety-seven patients with DDH in our hospital from January 2021 to January 2022 were randomly divided into two groups.Among them,48 patients in the control group received conventional ilioinguinal approach PAO treatment,while 49 patients in the study group received modified ilioinguinal approach PAO treatment.The surgical and postoperative rehabilitation indexes,Mckay clinical efficacy,lower limb line of force,complications,traumatic stress factors before and after surgery [adrenalin (NE),cortisol (COR),angiotensin Ⅱ (AngⅡ)],hip imaging indexes [anterior CE Angle (ACEA),lateral CE Angle (LCEA),acetabular index (AI)] and changes were compared between the two groups Good Harris hip function Score (mHHS),hip outcome score Daily Living Ability Scale (HOS-ADL).Results The operation time of the study group and the control group were (128.64±18.73) min and (141.80±21.59) min respectively,the intraoperative blood loss were (472.95±35.18) ml and (495.68±40.26) ml respectively,the postoperative drainage were (242.39±32.74) ml and (305.81±39.56) ml respectively,and the hospital stay were (11.57±2.29) D and (12.86±2.41) d respectively,with significant differences between the two groups (P<0.05);The excellent and good rate of McKay's clinical efficacy in the study group (95.92%) was higher than that in the control group (81.25%),and the differences were statistically significant (P<0.05);Serum NE in the study group and control group at 1 d,3 d,and 7 d postoperatively were (73.16±8.07) ng/L and (81.33±8.52) ng/L,(65.81±7.29) ng/L and (72.24±7.65)ng/L,(45.98±6.31) ng/L and (50.37±7.02) ng/L,respectively,and COR were (164.84±19.35) ng/L and (178.62±21.46) ng/L,(142.69±17.81) ng/L and (157.36±19.22)ng/L,(88.79±16.13)ng/L and (97.62±17.50)ng/L,respectively,and AngII was (138.74± 20.51)mmol/L and (150.19±21.36)mmol/L,(128.35±17.69)mmol/L and (137.18±19.24)mmol/L,and (119.82±17.41)mmol/L and (128.73±18.50)mmol/L,respectively,and the differences between the two groups were all statistically significance (P<0.05);ACEA at 3,6,and 12 months postoperatively in the study and control groups were (29.71±4.81)° and (27.68±4.53)°,(29.80±4.75)° and (27.72±4.60)°,(29.64±4.79)° and (27.63±4.51)°,respectively,and LCEA was (33.79±6.12)° and (31.04±5.83)°,(33.82±6.10)° and (31.10±5.90)°,(33.75±6.08)° and (31.05±5.77)°,and AI was (6.15±1.86)° and (7.03±1.94)°,(6.08±1.82)° and (7.01±1.89)°,(6.12±1.84)° and (7.06±1.90)°,respectively.mHHS scores was (72.15±7.65) and (68.23±7.71),(76.51±7.52) and (72.19±7.94),(90.13±5.16) and (86.76±5.72),and HOS-ADL scores were (79.92±7.50) and (76.26±7.62) points,(80.85±7.42) and (77.13±7.66) points,(89.73±6.37) and (86.25±7.15) points,and the differences between the two groups were statistically significant (P<0.05);the comparison of lower limb force lines and complications between the two groups showed no statistically significant differences (P>0.05).Conclusion Modified ilioinguinal approach PAO in the treatment of DDH can optimize the operation,reduce traumatic stress factors,further improve the curative effect,improve the status of femoral head coverage and hip function,and improve the quality of life,with high safety.

Key words: acetabular dysplasia；periacetabular osteotomy；approach mode；traumatic stress；lower limb force line；imaging；hip function