个性化术式治疗大龄先天性髋关节脱位

Treatment of congenital dislocation of the hip in older children with individualized surgeries

目的选择个性化术式治疗大龄先天性髋关节脱位,从而进一步提高治愈率,降低病残率。方法采用Pemberton骨盆旋转截骨,Dega骨盆旋转截骨,Chiari骨盆内移截骨,股骨转子下旋转截骨及股骨转子下短缩截骨不同个性化术式及其组合,治疗大龄先天性髋关节脱位26例34髋,根据Mck-ay临床康复评定标准评估治疗效果。结果随访2～6年,平均3年4个月。3髋股骨再骨折(8.3%),2髋术后股骨头再脱位(5.8%),6髋股骨头缺血坏死(17.6%)。治疗效果34髋中优10髋、良17髋、可6髋、差1髋,优良率为79.4%。结论根据患者的具体病情,选择个性化的手术方式,注重手术细节,并配合术后有效的功能康复,是降低大龄先天性髋关节脱位患者并发症和病残率,进一步提高疗效的关键。

Objective The older children with congenital dislocation of the hip were treated by individualized surgeries in order to increase cure rate and decrease modality rate. Methods 26 cases （34 hips） in older children with congenital dislocation of the hip were treated with Pemberton, Dega and Chiari pelvic osteotomies, femoral rotational osteotomy, femoral shortening osteotomy and individualized combined surgical procedures. Mekay clinical criteria was used to evaluate therapeutic effects. Results The cases were followed-up from 24 months to 6 years with 3 years and 4 months on average. There occurred femoral fractures in 3 hips （8. 3% ） ,femoral head dislocation in 2 hips（5.8% ） and femoral head ischemic necrosis in 6 hips（ 17.6% ） .Of 34 hips,the therapeutic effects were excellent in 10 hips,good in 17 hips,fair in 6 hips and poor in 1 hip. The excellent and good rate was 79.4%. Conclusions On the basis of analyzing patient＇ s clinical features, the surgeon should perform individualized operation while stressing on careful surgical skills and applying effec- tive functional exercises postoperatively. These measures are keys to decrease complication and mortality rate while increase therapeutic effects in older children with congenital dislocation of the hip.