开放复位加股骨短缩术治疗小儿发育性髋关节脱位的临床研究

Open reduction with derotational femoral shortening for developmental dysplasia of the hip in children

目的探讨开放复位加股骨短缩术治疗小儿发育性髋关节脱位(DDH)的临床疗效。方法回顾性分析本组11例(11髋)DDH患儿采用开放复位、股骨短缩术加Salter截骨术式治疗。其中男2例,女9例;左侧7例,右侧4例。患儿手术时年龄为2岁8个月～5岁3个月,平均3.5岁。按Tnnis系统分级:Ⅲ度2例,Ⅳ度9例。术前患肢缩短1.5～3.5cm,平均2.4cm。结果患儿随访时间1～6年,平均2.8年。股骨颈前倾角术前测量30°～50°,术中皆矫正至20°左右。术前髋臼指数35°～55°,术后矫正至17°～32°。术中股骨截骨长度1.0～2.5cm,平均1.6cm。McKay评分,优7髋,良4髋。股骨头缺血性坏死1例。结论对2～6岁之间的高脱位DDH患儿,开放复位术中发现复位困难或复位后压应力大时应行股骨截骨短缩术。

Objective To investigate the clinical results in the treatment of developmental dysplasia of the hip （DDH） in children using open reduction with derotational femoral shortening. Methods We retrospectively reviewed 11 patients （11 hips） presenting with DDH aged from 2 years and 8 months to 5 years and 3 months （mean age： 3 years and 5 months） who were treated by open reduction, combined with derotational femoral shortening and Salter pelvic osteotomv. There were two boys and nine girls. Among the 11 patients, four had the right hip involved, seven the left. The preoperative Tǒnnis system graded two hips grade 3, and nine hips grade 4. The involved limbs were shortened from 1.5 to 3.5 cm （mean 2. 4 cm）. Results The mean follow-up was 3.8 years （ 1 to 6 years）. The femoral neck anteversion was adjusted to about 20°, as judged from the preoperative measurement （ range, 30° - 50°）. The acetabular index was corrected to 17°- 32° （ preoperative range, 35°- 55°） . The extent of femoral shorting ranged from 1.0 -2.5 cm （mean, 1.6 cm）. According to the McKay criteria, clinical outcome was excellent in seven of the hips and good in four. In one patient, avascular necrosis was detected in MacEwen＇ s grade I. Conclusions For children aged 2 years to 6 years with high dislocation of the hip, femoral shorting should be performed when you found excessive pressure on the located femoral head during open reduction.