发育性髋关节脱位Dega骨盆截骨术并发症原因分析

Investigation of complications after Dega innominate osteotomy in developmental dislocation of the hip

目的探讨Dega骨盆截骨术治疗发育性髋关节脱位并发症的发生原因。方法回顾性分析2001年12月至2006年12月采用Dega骨盆截骨术治疗的发育性髋关节脱位病例59例(72髋),对其并发症情况进行分析。结果59例(72髋)中,发生并发症7例(7髋),其中3髋出现股骨头缺血性坏死,均为男性,并有闭合复位病史,手术年龄均小于2岁;3髋发生半脱位,1髋为髂骨截骨部位嵌入骨块移位,1髋为髂骨截骨远端下翻不充分,1髋为再脱位术后关节囊不能紧缩缝合;1髋活动受限,与髂骨截骨远端下翻过多及股骨短缩不充分有关。结论Dega骨盆截骨术发生并发症的原因主要与术前对髋关节脱位的病理变化了解不充分,术中没有掌握好髂骨截骨要领及头臼压力过大有关。

Objective To Investigate the causes of complications after Dega innominate osteotomy in developmental dislocation of the hip, Methods Complications after Dega innominate osteotomy in 59 cases of developmental dislocation of the hip with 72 hips were investigated retrospectively during Dec. 2001 to Dec, 2006, Results Complications appeared in 7 cases with 7 hips after Dega innominate osteotomy. Avascular necrosis developed in three hips that all patients was boy and underwent closed reduction preoperatively, Subluxation appeared in three hips, which one hip had dislodgment of the graft, one hip had the inadequate coverage of the femoral head due to insufficient displacement at the Dega osteotomy gap and one hip had the capsula not heing sutured tightenly, And one hip developed stiffness due to the excessive displacement at the Dega osteotomy gap and insufficiency of femoral shortening, Conclusions The main causes of complications after Dega innominate osteotomy in developmental dislocation of the hip were failure to get the message of preoperative pathological changes of the dislocated hip, failure to master skills surgical management and overpressure between the femoral head and the acetabulum.