成人高位先天性髋脱位的分次手术治疗

Staged surgery for severe congenital hip dislocation in adults

目的探讨不截骨情况下分次手术行全髋关节置换术的疗效。方法自2001年2月～2006年12月对12例成人高位先天性髋关节脱位患者采取一期手术松解,股骨髁上骨牵引。平均牵引重量18.5kg,牵引2～4周(平均18d)待脱位股骨头牵至髋臼水平后,二期行全髋关节置换术。结果随访6个月～5年,平均40个月。术后伤口均I期愈合,双下肢全部恢复等长,无血管神经损伤等并发症。术后和随访中未发现脱位及假体松动。Harris功能评分由术前41.6分提高到91.7分。结论成人高位先天性髋脱位的病理改变复杂,手术难度大,并发症多。采用分期手术治疗,一期松解牵引,二期关节置换的方法是避免股骨截骨、减少并发症、恢复肢体长度的良好方法。

Objective To evaluate the results of staged operations for severe CHD in adults. Methods From Feberary 2001 through December 2006, 12 adult patients with severe CHD were treated by two-stage operations. Arthrolysis and bone traction were performed at the first stage. The average weight of traction is 18.Skg and the traction time ranged from 2 to 4 weeks. The total hip arthroplasty was performed once the dislocated femoral head reached the level of the true acetabulum. Results The time of followed-up ranged from 6 months to 5 years with an average time of 40 months. The one-stage healing of incisions and the restoration of normal limb length was obtained in all the patients. No vascular and neurological complications were discovered. No dislocation and loosening of hip prosthesis were found at follow-up. The Harris score had increased from 41.6 to 91.7. Conclusions Severe CHD in adults has complex pathological changes and is a challenge to surgeons. Two-stage operation is a good method to avoid femoral osteotomy, reduce the complications and restore the limb length.