大龄儿童发育性髋关节脱位的手术治疗

Operation for developmental dysplasia of the hip in older children

目的总结不同手术方法治疗大龄儿童发育性髋关节脱位的疗效。方法1985年至2005年期间分别采用Salter截骨术、Pemberton截骨术和髋臼造盖成形术治疗6～15岁发育性髋关节脱位患儿56例(62髋)。结果31例(33髋)获平均8.5年(2.5～15年)随访,根据周永德疗效评定标准,优17髋、良11髋、中2髋、差3髋,总优良率为85%。Salter骨盆截骨术组优良率为87%;Pemberton截骨术组优良率为83%,1例股骨头坏死;髋臼造盖成形术组优良率为85%,1例股骨头坏死,1例严重髋关节僵硬;同时行股骨粗隆下截骨的22例(23髋)中无一例发生股骨头坏死和术后脱位。结论正确选择术式是大龄儿童发育性髋关节脱位获得良好疗效的关键,术式的选择主要根据病理变化和年龄。股骨粗隆下截骨能有效降低头臼压力,减少股骨头坏死和再脱位发生率。

Objective To discuss the effect of different operation methods for developmental dysplasia of the hip in older children. Methods From 1985 to 2005, 56 patients （62 hips）, age from 6 to 15 years old, were treated by Salter osteotomy, Pemberton osteotomy and Shelf procedure, Results 31 patients（33 hips） were followed up for 2. 5 to 15 years（average of 8. 5 years）. According to the criteria of ZHOU Yong de, the result of 17 hips were excellent, 11 hips good, 2 hips fair, 3 hips poor. The rate of excellent and good result was 85%. In Salter osteotomy group, the rate of excellent and good result was 87%, in Pemberton osteotomy group, the rate of excellent and good result was 83%, with avascular necrosis in 1 case, in Shelf procedure group, the rate of excellent and good result was 85%, with avascular necrosis in 1 case and hip stiffness in 1 case. 22cases（23 hips） had a concomitant femoral shortening, no avascular neerosis and redislocation were found. Conclusions To choose the right operation method is the key to excellent prognosis of developmental dysplasia of the hip in older children, and the choice of operation method depends on pathological condition and the patient＇s age, Femoral shortening can reduce the pressure at the joint effectively, decrease the rate of avascular necrosis and redislocation.