一期Salter截骨联合股骨近端截骨在3~8岁延迟治疗发育性髋关节脱位中的应用

One-stage operation consisting of Salter' s and proximal femor osteotomy in the treatment of late developmental dislocation of the hip between the ages of three and eight years

[目的]探讨应用一期Salter截骨联合股骨近端截骨在3～8岁延迟治疗发育性髋关节脱位(LDH)的临床疗效及优势。[方法]回顾性分析本院2006年6月～2008年4月对3～8岁之前未经治疗的34例(39髋)发育性髋关节脱位患儿采用无术前牵引的一期联合手术治疗的临床资料。共34例(39髋),男5例,女29例;右髋16例,左髋17例,双髋3例;按照Tonn is分级,Ⅱ级4髋,Ⅲ级16髋,Ⅳ级19髋,术前髋臼指数平均33°(28°～42°);手术年龄平均4.5岁(3～8岁)。[结果]术后病人全部获得随访,平均随访3.5年(2.5～4年3个月),术后改善髋臼指数平均15.5°(10°～20°),1髋(2.5%)半脱位,1髋(2.5%)发生股骨头坏死征。按照Mckay临床评定标准,其中优11髋(28%),良23髋(59%),可3髋(8%),差1例(3%),优良率89%。Severin X线评定标准:优13髋(33%),良23髋(59%),可2髋(5%),差1例(3%),优良率92%。[结论]一期联合手术无需术前牵引,能同时纠正髋关节软组织和骨性病理改变。减少术后并发症发生率,增加关节功能优良率。减少患儿痛苦及住院时间。效果优良,值得在适合的病例中推广。

[Objective]To investigate the clinical results and advantages of one-stage operation consisting of Salter＇s and proximal femor osteotomy for late developmental dislocation of the hip（LDH） between the ages of three and eight years.[Methods]A retrospective analysis of the clinical data was made for thirty-four children（thirty-nine hips） who had not received any treatment before between the ages of three and eight years for the treatment of LDH at our hospital between June 2006 and April 2008.There were 29 girls and 5 boys.Sixteen hips were on the right side,17 hips on the left side and 8 bilateral.According to Tonnis classification,4 hips,16 hips and 19 hips were graded as Ⅱ°,Ⅲ°and Ⅳ°respectively.Before the operation,the average acetabular index were 33°（range from 28°to 42°）.And the average age was 4.5 years（range from 3 years to 8 years）.[Results]All cases were followed up for average time of 3.5 years（range from2.5 years to 4 years and three months）.After the operation,the average acetabular index was improved by 15.5°（range from 10°to 20°）.One of the hips had subluxation（2.5%）,one（2.5%）hip appeared the sign of avascular necrosis of femur head.The functional result was assessed.According to Mckay＇ s classification,11 hips（28%）had an execellent result,23 hips（59%） a good result,3（8%） a fair result and 1（3%） a poor result.The execellent and good rate was 89%.According to Severin classification of the radiographic appearance,13 hips（33%） had an execellent result,23（59%） a good result,2（5%） a fair result and 1（3%） a poor result.The execellent and good rate was 92%.[Conclusion]This one-stage combined operation without preliminary traction can correct the soft tissue and the bone pathological changes of the hip at the same time,lower the incidence of postoperative complications and increase the execellent and good rate of the hip,and also reduce the children＇s pain and the time in hospital.The result was execellent and good.It deserves popularization in those suitable patients.