发育性髋关节脱位闭合复位后髋臼发育的研究

A STUDY OF ACETABULAR DEVELOPMENT AFTER CLOSED REDUCTION IN DEVELOPMENTAL DISLOCATION OF THE HIP

目的通过回顾性研究,观察闭合复位治疗发育性髋关节脱位的临床疗效,动态分析闭合复位后髋臼发育的特点。方法2002年1月-2005年12月,采用闭合复位治疗100例单侧发育性髋关节脱位患儿。男18例,女82例;年龄7～36个月,平均19.4个月。左侧68例,右侧32例。髋关节脱位按Zionts等方法分度,Ⅰ度15例,Ⅱ度50例,Ⅲ度26例,Ⅳ度9例。治疗时行内收肌切断与牵引74例,直接闭合复位26例。按四级功能评价标准判定临床疗效;于复位前、复位后第3、6、9和12个月动态测量患、健侧髋关节的髋臼指数(acetabular index,AI)和髋臼深度与宽度比值[acetabular index of depth to width,AI(D/W)],并进行相关比较。结果治疗12个月功能恢复总优良率达88.00%。复位后12个月,患侧AI由治疗前(37.17±2.17)°下降至(27.02±3.54)°,AI(D/W)由22.06%±1.65%增长至29.80%±3.56%,各时间点比较差异均有统计学意义(P<0.01);患侧AI下降幅度、AI(D/W)增长幅度明显快于健侧(P<0.01)。复位后1～3个月、10～12个月AI分别为(3.22±1.42)°和(3.41±2.03)°,AI(D/W)分别为2.69%±1.83%和2.33%±1.13%,明显快于其他时间段(P<0.01);各时间段患侧AI下降幅度、AI(D/W)增长幅度均明显快于同期健侧(P<0.01)。复位后12个月,7～12月龄、13～18月龄AI分别为(13.71±3.96)°和(11.48±4.15)°,AI(D/W)分别为9.95%±3.81%和8.28%±3.58%,明显快于其他年龄段患儿(P<0.05);各年龄段患侧AI、AI(D/W)变化速度均明显快于健侧(P<0.01)。结论闭合复位治疗发育性髋关节脱位操作简便,治疗效果良好,在治疗后12个月内,患侧髋臼发育速度明显快于健侧;患侧髋臼的发育高峰期在复位后1～3个月和10～12个月;患儿年龄<18个月为闭合复位治疗发育性髋关节脱位的最佳时期。

Objective Through a retrospective study, to observe the clinical therapeutic effect for closed reduction treatment of developmental dislocation of the hi p （DDH）, and to dynamically analyze characteristics of acetabular development after closed reduction in DDH. Methods A total of 100 single side DDH children who were treated by ＂the treatment mode of closed reduction＂ from January 2002 to December 2005 were followed up, including 18 males and 82 females, with the average age of 19.4 months （ranging from 7 months to 36 months）. Sixty-eight patients had left side dislocation, while 32 had right side dislocation. According to Zionts dislocation grades, 15 cases were degree Ⅰ, 50 degree Ⅱ, 26 degree Ⅲ and 9 degree Ⅳ. Adductor tenotomies and skeletal traction were carried out in 74 cases, while direct dosed reduction was performed in 26 cases. The four-level functional evaluation criterion was used to assess the clinical therapeutic effect. Lesional and homeochronous normal hi ps were paired, and acetabular index （AI） and AI （D/W） of lesional and normal hi ps, before the reduction and in the 3rd, 6th, 9th and 12th month, respectively, after the reduction, were dynamically measured. Results The total choiceness rate of 100 children was 88.00%. Twelve months after the reduction, lesional AI decreased from （37.17 ± 2.17） ° to （27.02± 3.54） °, while lesional AI（D/W） increased from 22.06% ± 1.65% to 29.80% ± 3.56%, and the differences among each time-point had statistical significance （P 〈 0.01）. Both rates of lesional AI decrease and AI（D/W） increase were obviously faster than those of normal side physiological development （P 〈 0.01）. In all durations after 12 months reduction, the rates of lesional AI were （3.22± 1.42） o and （3.41 ± 2.03） o in 1 - 3 months and 10 - 12 months, respectively, and the rates of AI（D/W） were 2.69% ± 1.83% and 2.33% ± 1.13%, respectively, and they were obviously faster than the other durations （P 〈 0.01）. Both rates of lesional AI decrease and AI（D/W） increase were obviously faster than the homeochronous rate of normal side physiological development in each duration （P 〈 0.01）. The rates of lesional AI were （13.71 ± 3.96） o and （11.48 ± 4.15） o in 7 - 12 age group and 13 - 18 age group, respectively, and the rates of AI（D/W） were 9.95% ± 3.81% and 8.28% ± 3.58%, respectively, and they were obviously faster than the other age groups （P 〈 0.05）. Both changes of lesional AI and AI（D/W） were obviously faster than the homeochronous changes of normal side in each age group（P 〈 0.01）. Condusion There are simple operating requirements and fine therapeutic effect of＂the treatment mode of closed reduction＂. Within 12-month after the dosed reduction treatment, the rate of lesional acetabular development is obviously faster than that of normal side physiological development. The cresttime of lesional acetabular development is during 1 - 3 months and 10 - 12 months, and the best treatment time of closed reduction is the age before 18 months.