组合术式治疗大龄儿童先天性髋关节脱位的临床研究

Combined Operation Treatment of Congenital Dislocation of Hips in Older Children

【目的】设计并使用组合术式治疗大龄儿童先天性髋关节脱位(CDH),以降低股骨头坏死率及髋关节病残率,提高治愈率。【方法】自1990年至2006年作者使用组合术式(切开复位+骨盆内移截骨+髋臼成形+股骨转子下旋转缩短截骨术)治疗大龄儿童(7-15岁)CDH 67例91髋,随访时间1年至15年3个月,平均随访时间7年4个月。【结果】本组病例依照Trevor评分优良率达到81.3%,股骨头无菌性坏死15髋,占16.5%,髋关节僵硬12髋,占13.2%,比照Salter标准,股骨头坏死率和病残率明显降低。【结论】组合术式治疗大龄儿童CDH疗效良好,它符合髋关节生物力学特点,符合患儿病理解剖特点;利用组合术式优势降低了股骨头坏死率及髋关节病残率,提高了治愈率。

[Objective]To investigate how to increase the cure rate , reduce necrosis rate of femoral head and stiffness rate of hip joint in the operation for congenital hip dislocation. [Methods]Form 1990 to 2006, 91 hips in 67 cases of congenital hip dislocation aged 7-year to 15-year old, were treated by combined operation, and were followed-up from 1 year to 15 years and 3 months（average,7 years and 4 months）. [Results]According to the modified rating system of Trevor, 81.3 % of the whole series had a good or excellent result. Fifteen （16.5%） ischemic necroses of femoral head occurred . The rate of ischemic necrosis of the femoral head and joint stiffness of hip in older age children after operation were reduced obviorsly according to the standard by Salter. [Conclusion]The combined operative treatment improves the biomechanical relation of the hip. It＇s preferred in treating the congenital hip dislocation of older age children. It reduces the rate of ischemic necrosis of femoral head and joint stiffness of hip and increases the rate of cure.