18～36个月发育性髋脱位闭合复位的远期疗效评价

Long term curative effect for DDH treatment by combined close-reduction in children between 18 -36 months old

[目的]评估内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗18～36个月婴幼儿发育性髋脱位（developmental dislocation of hip，DDH）的远期效果。[方法]随访1993年1月～2001年12月在本院采用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗有完整资料的18～36个月DDH患儿156例232髋，其中Ⅰ度77髋，Ⅱ度95髋，Ⅲ度60髋，随访时间为5．5～14．5年，平均9．2年，并对全部病例进行影像学检查和髋关节功能评价。[结果]根据周永德发育性髋脱位疗效评价标准，本文195髋复位满意，优良率为84．05％，9例发生股骨头坏死；术前平均髋臼指数（AI）：复位成功髋（35．34°±5．95°），失败髋（44．51°±5．32°），成功髋复位前AI均数明显小于失败髋均数；Ⅰ度优良率为84．41％，Ⅱ度优良率为85．21％，Ⅲ度优良率为81．67％。[结论]内收肌切断、手法闭合复位、改良蛙式石膏固定方法对18～36个月DDH患儿是一种有效的治疗方法，复位前AI值的大小对于DDH保守治疗方法的选择和远期疗效评估具有一定的指导意义，而脱位程度不是能否采用手法复位的标准。

[ Objective] To evaluate long term curative effect on treatment of developmental dislocation of hip （DDH） in children between 18 - 36 months old by combined close-reduction method of adductor-cut, close-reduction and frog type plaster fixation. [ Method] One hundred and fifty-six children （232 hips） treated by combined close-reduction method in 1993 to 2001 were followed-up with mean follow-up time of 9. 2 （5.5 - 14.5） years. There were 77 hips of grade Ⅰ dislocation, 95 hips of grade Ⅱ, and 60 hips of grade Ⅲ according to Zhou Yongde grading criteria. Periodical imaginological and hip joint function examinations were evaluated and analyzed. [ Result] One hundred and ninety-five hips obtained satisfactory concentric reduction with excellent and good rate of 84. 05% according to Zhou Yongde criteria. There were 9 hips with femoral head necrosis at follow-up. Mean preoperative acetabular index （AI） of successful reduction hips was （35.34 ± 5.96） % , and that of failure reduction hips was （44.51 ± 5.32） %. The excellent and good rate were 84. 41% in cases of gradeⅠ hips, 85.21% in grade Ⅱ hips, and 81.67% in grade Ⅲ hips. [ Conclusion] Combined method of adductor-cut, close-reduction and frog type plaster fixation is an effective way for treatment of DDH of children between 18 - 36 months old. Preoperative AI but not degree of dislocation is the criteria to determine whether close-reduction is necessary or not.