贯通式髋臼造盖术治疗小儿先天性髋关节脱位

Penetrating Artificial Cap for Treatment of Congenital Dislocation of Hip

我院１９８８年以来采用自行设计的贯通式髋臼造盖术治疗ＣＤＨ３１例，通过临床实践，我们认为该手术方法比较简单可靠。手术方法为：股骨头复位后，于髋臼外缘凿一２５ｃｍ长方形骨槽，其深度贯通髂骨内板。骨槽方向为前下后上并与水平线成３０°角。从髂骨切取２ｃｍ×３ｃｍ×４ｃｍ梯形骨块，骨块凹面向下，短底边先插入骨槽内然后缓缓击入，直至骨块于髂骨内板穿出为止。用手摇晃嵌插的骨块不动为好。股骨头复位后紧缩缝合关节囊。本文介绍了手术设计思想，手术设计的生物力学合理性，手术要点。本组病例术前髋臼指数平均为３６°，术后为２１°，髋臼形态由斜坡状变为球窝状的变化率为７４％。股骨头覆盖率由术前１９％变为术后８６％，文章强调手术操作的准确性，并同时强调切取骨块要足够大。

We had used penetrating artificial cap designed by ourselves to treat CDH 31 cases since 1988.Based on the clinical practice,we considered that the procedure is simple and effective.Operation was as follow:after femoral head reduction,a rectangle bone groove was made on the superior edge of the acetabulum,and throughout medial ilium plate.Direction of the bone groove was ante inferior to post superior,and form 30° angle.A 2×3×4cm rectangle bone block was removed from ilium,concave of the bone block directed to inferior,short side bone block was inserted in the bone slot and stricken slowly untile the bone block throughout medial ilium plate.This article reported the design,biomechanical and key ponts of operation.Acetabulum index was 36° average in all cases before operation and it reduced to 21° average after operation,changing rate of acetabular shape was 74% from slope to ballsocket,covering rate of femoral head was 19% before operation and 86% after operation. Careful procedure is important,and bone block is large enough,otherwise,the operation will be failure.