Ye Wensong,Li Haibing,Xu Lujie,et al.Causes and countermeasures for relapse after open reduction for developmental dysplasia of the hip.[J].Journal of Clinical Pediatric Surgery,,17():747-752.
Causes and countermeasures for relapse after open reduction for developmental dysplasia of the hip.
Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R]
volume:
第17卷
Number:
2018 10
Page:
747-752
Column:
专题讨论
Date of publication:
2018-10-25
- Keywords:
- Hip Joint/GD; Dislocations; Reoperation; Femur Head Necrosis; Child
- Document code:
- A
- Abstract:
- ObjectiveTo explore the causes and countermeasures for relapse after open reduction for developmental dysplasia of the hip,observe the clinical effect of revision surgery and provide rationales for preventing and treating redislocation.MethodsA review was conducted for 10 patients (10 hips) undergoing revision surgery between January 2012 and January 2017.All initial open reductions were completed at our hospital.Analyses were performed with regards to when and why redislocation occurred,timing of interventions and specific strategies.The function and radiographic results of the hip and the incidence rate of osteonecrosis was analyzed.ResultsAll cases were available for the final followup.The average followup period was 2.1 (1~4) years.The average time interval between redislocation and initial open reduction found was 5.3 months (1 day36 months).After reoperation,there were joint adhesion (n=2),fibrous tissue (n=3),infolded labrum and transverse ligamentum obstructing central reduction (n=1),residual ligamentum teres (n=1),rupture of joint capsule (n=2) and relaxation of joint capsule (n=4).According to the McKay criteria at the final followup,3 hip (30%) achieved excellent (1 hip) and good (2 hips) clinical results.According to the Severin criteria,6 hips (60%) yielded excellent (1 hip) and good (5 hips) radiographic results.The incidence rate of avascular necrosis of femoral head was 70%.ConclusionMost cases of failed reduction for developmental dysplasia of the hip are caused by inadequate softtissue release and capsulorrhaphic failure.Widening of medial joint space is an ominous sign of redislocation.Releasing intraarticular adhesions and dissection of joint capsule and pruning and constricting suture are essential for maintaining central reduction.There are many potential complications of revision surgery after redislocation and the longterm followup outcomes remain poor.
Last Update:
2018-10-24