7～16岁儿童Ⅲ度发育性髋关节脱位的手术治疗(附40例报告)

Surgical treatment for elder children with Grade Ⅲ developmental dislocation of the hip(report of 40 cases)

目的通过手术治疗7～16岁儿童Ⅲ度发育性髋关节脱位,以改善髋关节解剖关系,即股骨头和髋臼达到同心性或中心性复位,减轻髋部疼痛、跛行,减少脱位引发的晚期并发症。方法回顾性分析1995-2006年手术治疗的7～16岁儿童发育性髋关节脱位40例(48髋)的临床资料,其中左侧19例(19髋),右侧13例(13髋),双侧8例(16髋)。复位前经股内侧切口做内收肌及髂腰肌松解后骨牵引2～3周,采用改良的Dega不完全经髂骨截骨术。改良的Chiari骨盆内移截骨及股骨短缩旋转截骨,术后单髋人字石膏制动4～6周。结果术后随访3～10年(平均5年),采用改良Mckay评分:优13髋,良18髋,可14髋,差3髋;Severin评分:ⅠA级(优)20髋,ⅠB级(良)1髋,Ⅱ级(良)6髋,Ⅲ级(可)17髋,Ⅳ级(差)3髋,Ⅵ级(差)1髋。结论虽然大龄儿童Ⅲ度发育性髋关节脱位病变严重、手术治疗困难、术后并发症多,但仍强调手术治疗的可行性和必要性。采用以上术式临床可获满意疗效。

Objective To investigate the curative effect of operation for elder children with grade Ill developmental dislocation of the hip in order to recuperate the normal anatomy, relieve the clinical symptoms such as the pain of hip and limp, reduce terminal complications of the dislocation of hip, and contribute to prosthetic replacement of acetabulum and femoral head in the future. Methods Clinical data of 40 cases （48 hips） of elder children in the age of 7 - 16 years old with Grade 11I developmental dislocation of the hip （DDH） who were admitted to in our department between 1995 and 2006 were retrospectively analyzed ;26 girls and 14 boys underwent open reduction with modified Dega osteotomy ,or modified Chiari iliac osteotomy and femoral shortening or derotational varus/valgus osteotomies at the same time ;19 were on the left side, 13 on the right side and 8 bilateral. Preoperative femoral traction were manipulated for about 2 - 3 weeks after adductor and iliopsoas muscle had been abscised. A postoperative spica cast was performed for about 4- 6 weeks. All of the patients were followed up for about 3 - 10 years and clinical outcomes were assessed using the modified McKay criteria and radiographic outcomes were evaluated using the modified Severin method to measure the Sharp acetabular angle and the center - edge angle. Results According to modified McKay criteria, 13 hips were excellent, 18 good, 14 fair,3 poor; and accoraing to modified Severin criteria,20 hips were excellent（ⅠA） , 1 good（ⅠB） ,6 good（Ⅱ） , 17 fair（ Ⅲ ） ,3 poor（Ⅳ ） , 1 poor（ Ⅳ ）. Conclusion Elder children with Grade Ⅲ developmental dislocation of the hip is difficult to management for its severe pathological changes severity and operative treatment is difficult and postoperative complications are much higher, but the feasibility and necessity of operation Should be underlined. And our experiences demonstrate that satisfactory therapeutic effect can be achieved after rational operation methods to be adopted.