先天性髋脱位闭合复位后股骨头缺血性坏死的长期随访

A Long term Follow up of the Avascular Necrosis Following Closed Reduction of the Congenital Dislocation of the Hip

目的：对１９８５年１月～１９８９年１２月采用闭合复位、蛙式支架治疗的患儿作了平均１０年的长期随访，评价了股骨头缺血性坏死（以下简称头坏死）发生率和各种影响因素，探讨头坏死与Ｘ线结果、临床功能之间的关系，提出预防头坏死的方法和措施。方法：本组６４例共７９髋，复位时的平均年龄为２１个月，１８髋术前行皮牵引，５１髋术前行内收肌切断。闭合复位均在全麻下施行，成功后穿戴蛙式支架６个月，然后改为贝氏架３个月，共穿戴９个月。结果：平均随访时间为１０年４个月，随访时平均年龄１１．７岁。７９髋中３６髋出现头坏死（４６％）。不同性别、不同脱位侧别、复位前是否行皮牵引和内收肌切断的头坏死发生率的差异均无显著性意义（Ｐ＞０．０５），头坏死发生率与脱位程度及复位后制动体位关系密切。闭合复位前，股骨头骨骺未出现，发生头坏死率明显升高（Ｐ＜０．０５），多为股骨头全部受累。复位时年龄小于１８个月者，其头坏死发生率明显低于１８个月之后复位者（Ｐ＜０．０５）。随访时临床功能优良率为８３％，而Ｘ线片的优良率则是６０％。结论：临床功能障碍的出现是一个缓慢、渐进的过程，相当时间内并不产生髋关节疼痛和跛行。对远期疗效的估计应以Ｘ线变化为主要依据。

Objective: Sixty four patients with seventy nine congenital dislocated hips(CDH) in which avascular necrosis (AVN)developed after closed reduction were followed up for an average of 10.3 years from the time of reduction. The incidence and consequences of AVN were studied. Methods: Medical records and radiographs of all patients with CDH undergone a closed reduction between 1985- 1989 were examined retrospectively. Radiographs were scrutinized to identify the signs of AVN described by Salter. Results: Of the 79 hips, 36 (46%) had some evidence of avascular necrosis. The incidence was not influenced by sex and age, the duration of traction or the use of adductor tenotomy ( P >0.05). AVN was highly associated with degree of preoperative displacement, the age at the time of reduction and the applied frog abduction brace ( P <0.05). Conclusion: The presence of the ossific center had a protective effect against AVN. Patients who have an evidence of AVN tended to function well for many years despite a radiographic result that was not as good as the anatomical picture.