Pemberton手术加短缩截骨治疗大龄发育性髋脱位临床分析

Clinical analysis of treating the developmental dislocation of the hip in old age children by Pemberton operation and femoral shortening

[目的]应用Pemberton截骨术加股骨近端粗隆下短缩旋转截骨为主多种辅助手段一期手术治疗大龄发育性髋脱位，评估术后髋脱位股骨头坏死和关节僵硬的发生率。[方法]自2002年6月～2006年12月用Pemberton截骨术加股骨粗隆下短缩旋转截骨为主多种辅助手段治疗大龄（7—14岁）发育性髋脱位149例，随访到101例（136髋），随访1年2个月-5年6个月，平均2年7个月。辅助手段包括：（1）术中髂腰机及内收肌切断；（2）单髋人字石膏制动；（3）术后4～6周拆石膏住院CPM活动髋关节加主动功能锻炼；（4）髋关节早活动晚负重。[结果]术后髋关节脱位16髋，占11．76％。按照Salter提出的股骨头坏死的诊断标准，136髋中股骨头坏死38髋占27．94％。髋关节屈曲少于90°者31髋占22．79％。[结论]Pemberton髋臼周围截骨结合股骨粗隆下短缩截骨一期手术治疗大龄发育性髋脱位，疗效可靠，降低了术后再脱位、股骨头坏死率及髋关节僵硬等并发症的发生率。

[ Objective] To review the treating effect of cases of the developmental dysplasia of the hip in old age children by a one - stage combined Pemberton operation and femoral shortening and investgate if the hip joint stiffness rate and ischemic necrosis rate of femoral head after operation are reduced. [ Method] From June 2002 to Decempber 2006, 136 hip congenital dislocation of 101 old age children （7 years to 14 years） were treated by Pemberton operation and femoral shortening, and were followed- up from 1.5 years to 4 years （average, 2 years and 7 months） . [ Result] Thirty -one cases can only bend their hip joint below 90 degrees, accounting for 22.79% of all. Thirty - eight ischemic necrosis of femoral head occurred which accounted for 27.94%. The rate of ischemic necrosis of the femoral head and hip joint stiffness of old age children after operation were reduced obviously according to the standard by Salter. [ Conclusion] Pemberton operation and femoral shortening are preferred in treating the developmental dysplasia of the hip of old age children. It can reduce the rate of ischemic necrosis of femoral head and hip joint stiffness.