Salter骨盆截骨术治疗学步期发育性髋关节脱位

Salter osteotomy for developmental dysplasia of the hip in children of walking age

目的介绍Salter骨盆截骨术在学步期发育性髋关节脱位(DDH)患儿中的治疗指征和手术要点,探讨Salter骨盆截骨术早期干预"学步期"DDH患儿的重要意义。方法2002年12月～2005年12月,采用Salter骨盆截骨术治疗DDH患儿29例,3例为多关节挛缩。男8例,女21例;年龄12～18个月,平均16.59个月;双侧12例,左侧11例,右侧6例。共计手术31髋,全脱位25髋,半脱位6髋。所有病例完善术前检查后不作牵引直接行Salter骨盆截骨术。术后髋人字石膏固定2个月,双下肢皮肤牵引,床上关节活动1个月后下地负重行走。结果所有病例术后2个月,6个月,1年,之后每年1次连续随访。随访6～42个月,平均21.76个月。X线疗效按照Severin分级:Ⅰ级28髋,Ⅱ级3髋,Ⅲ级0髋。临床疗效优28髋,良3髋,可0髋,差0髋。结论根据国外的报道和我们的经验,对12～18个月处于"学步期"年龄段的全脱位和严重半脱位类型的DDH患儿采用Salter骨盆截骨术与保守治疗相比,可以在确保髋关节有效复位的同时,降低股骨头缺血坏死的发生率,避免二次手术,缩短疗程,对多关节挛缩髋脱位也具有良好的疗效,是一种安全、有效的手术方法。

Objective To introduce the indication and main points of Salter osteotomy for the developmental dysplasia of the hip （DDH） in children aged from 12 to 18 months. Methods Twenty- nine cases （3 with arthrogryposis, 31 hips） were treated by Salter osteotomy in this hospital from Dec. 2002 to Dec. 2005. Among them, 25 were dislocation and 6 were subluxation, Their age ranged from 12 to 18 ms （average 16. 59 ms）. All cases were performed Salter osteotomy with capsular reconstruction and no osteotomy for femoral shorten or rotate without traction pre-operation. Then 2 ms spica cast immobilization and 1 ms skin traction of lower extremity were applied to these patients. Results All cases were followed up at 2, 6, 12 ms post-operation and then every 1 year in series, aver- age for 21.76 ms. According to Severin classification system for evaluating radiographic outcome, 28 hips was grade Ⅰ , 3 in grade Ⅱ and none in grade Ⅲ. On the basis of hip function, 28 hips were good, 3 fair and no bad. Conclusions Salter osteotomy is a safe and effective method in the treatment of dislocation or severe subluxation of the hip in walking age （between 12 to 18 ms）. Compared with conservative treatment, Salter osteotomy is better in lowering the incidence of avascular necrosis and avoiding second-time surgery. Moreover, it also works in treating the hip dislocation of arthrogryposis cases.