牵引复位有限制动治疗发育性髋关节脱位的远期疗效

The long-term effects of developmental dislocation of hips by closed reduction and limited immobilization after preliminary traction

目的采用牵引复位、功能性装具有限制动治疗发育性髋关节脱位（DDH）患儿，评价其远期治疗结果。方法选择1983年7月至2001年7月的86例（119髋）DDH患儿，初诊时平均年龄为19．5个月，经平均18d牵引后配戴功能性装具。除6例（9髋）在全麻下复位外，其余80例（110髋）均在床旁成功复位，仅有1例（2髋）做了内收肌切断术。配戴功能性装具平均为10．4个月。结果平均随访时间为10年2个月，21例随访至骨骼成熟Y型软骨骺闭合。随访时临床优良率为85．7％（102／119），放射学评估优良率为77．3％（92／119）。8例（8髋）发生股骨头缺血性坏死（6．7%）；8髋在复位后有部分或全部骨骺核出现不规则骨化。19例（26髋）由于残余畸形于保守治疗结束后3～8年施行了补充性手术。结论牵引复位功能性装具有限制动是治疗DDH的一种确切、有效、并发症相对较低的方法；对DDH的保守治疗，要做长期随访。

Objective To evaluate the long-term effects for patients with developmental dislocation of hips （DDH） by closed reduction and limited immobilization. Methods From Jul 1983 to Jul 2001, 86 patients with 119 dislocated hips were enrolled into this study. The mean age when the patients were diagnosed was 19. 5 months. After traction for 18 days, the functional apparatus was applied on all the patients averagely for 10. 4 months. One hundred and ten dislocated hips of 80 cases were repositioned at bedside, 9 hips of 6 cases were repositioned under general anesthesia and only 2 hips of 1 case underwent the tenotomy of the adductors at both sides. Results The mean following up period was 10. 2 years. Twenty-one patients were followed up until the epiphyses were closed. X-ray showed that the excellent and good rate was 77. 3 %. Mckays clinical evaluation showed that the excel- lent and good rate was 85.7%. Eight hips （6. 7%） got avascular necrosis of the femoral head, 8 hips got irregular ossification in all or part of the epiphyseal nucleus. Twenty-six hips in 19 cases underwent secondary procedures due to residual deformity at 3 to 8 years after the prior treatment. Conclusions Closed reduction and limited immobilization after prior traction is an effective method to treat patients with DDH with fewer complications. The long-term follow-up is necessary to evaluate curative effect of the treatment of DDH by closed reduction.