XU Rui-jiang,HONG Xi-wei,YU Xiang-hua,et al.Surgical management for redislocation after open reduction of developmental dislocation of the hip in older children[J].Journal of Clinical Pediatric Surgery,2010,9(02):0.
大年龄儿童发育性髋脱位术后再脱位的治疗
- Title:
- Surgical management for redislocation after open reduction of developmental dislocation of the hip in older children
- Keywords:
- Hip Dislocation; Development; Surgical Operation; Complication; Older Children
- 摘要:
- 目的 探讨大年龄儿童发育性髋脱位术后再脱位的治疗方法及效果。方法 2001年12月至2008年6月，本院经手术治疗大年龄儿童发育性髋脱位术后再脱位11例（11个髋）。平均手术年龄8 (6 ~ 13)岁。均采用再次切开复位手术，其中实施Dega骨盆截骨术7例，Staheli髋臼延伸术3例，Chiari截骨术1例。8例实施股骨近端缩短、旋转截骨。 结果 髋关节功能根据McKay的临床评定标准，6个髋关节为优，3个髋关节为良，2个髋关节为可。X线片结果采用Severin的评定标准，5个髋关节为优，4个髋关节为良，2个髋关节为可。结论 大年龄儿童发育性髋脱位术后再脱位的治疗应根据髋关节的病理变化，选择切开复位、个性化髋臼手术和股骨近端缩短、旋转截骨，以实现髋关节中心性复位。
- Abstract:
- Objective To find out how to treat the hip redislocation after open reduction of developmental dislocation of the hip in older children. Methods Eleven patients with 11 redislocated hips underwent surgical procedures betreen 2001.12 to 2008.06. The mean age of the surgical procedure was 8 years (6 to 13). All hips needed open reduction and seven underwent Dega osteotomy, three Staheli augmentation and one Chiari osteotomy. Eight hips needed femoral shortening and derotation osteotomy. Results According to Mckay's criteria, 6 cases got excellent clinical results，3 cases good results and 2 cases fair results. Xay showed that 5 hips got excellent results , 4 good results and 2 fair results by Severin's criteria. Conclusions The surgical management for redislocation after open reduction of developmental dislocation of the hip depended on the patient's pathological changes of the hip. Open reduction, individual acetabular osteotomy and femoral shortening and derotation osteotomy are the keys to acquire the central reduction of the hip.
参考文献/References:
1 McKay DW. A comparison of the innominate and the pericapsular osteotomy in the treatment of congenital dislocation of the hip[J]. Clin Orthop, 1974, 98:124-132.
2 Ward WT, Vogt M, Grudziak JS, et al. Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip[J], J Bone Joint Surg, 1997,79A(5):656-663.
3 许瑞江,马承宣,赫荣国,等. 先天性髋关节脱位术后再脱位原因分析[J]. 临床小儿外科杂志，2002，1（2）：81-83.
4 范毓华，黄禄基，楼跃，等.沙氏手术治疗发育性髋脱位术后再脱位的临床研究[J].中华骨科杂志，2002，22（4）：206-207.
5 Grudziak JS, Ward WT. Dega osteotomy for the treatment of congenital dysplasla of the hip[J]. J Bone Jont Surg, 2001, 83A(6):845-854.
6 黄耀添, 雷伟. 先天性髋脱位术后再脱位的防治[J].中华小儿外科杂志，1995,16(2):108-109.
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备注/Memo
1，解放军总医院小儿外科（100853，北京）；2，揭阳市东山区第一人民医院骨科（广东，522000）。E-mail:xurj@301hospital.com.cn