新生儿急性化脓性髋关节炎后遗病理性脱位的治疗与预防

The treatment and prevention of pathological dislocation of the hip following septic arthritis in the newborns

目的探讨新生儿急性化脓性髋关节炎后遗病理性脱位的防治措施。方法对 38例中 20例作临床系统性回顾。 20例均行切开复位，其中还同时行大转子下移术 13例，大、小转子关节成形术 2例。 14例行髋臼重建术。结果术后近期复位成功率达 90％，但获中心性复位仅 38.8％。经 6个月～ 12年随访，多数病例疗效满意，髋关节无疼痛，稳定性增加，活动度也逐渐加大。部分头颈吸收破坏者疗效不尽人意，表现为短肢畸形、活动受限甚至纤维强直，并有半脱位、脱位各 1例。结论以大转子下移术为主的联合手术对重塑股骨头和髋臼、促进复位、保持复位后的稳定性具有很大作用，对头臼结构严重破坏、疗效欠佳的病例除了进一步改善治疗方法外，重视新生儿急性化脓性髋关节炎的早期诊断和早期切开持续引流，是预防病理脱位，减少股骨头颈、髋臼破坏的关键，可从根本上防止此后遗症的发生而提高疗效。

Objective To evaluate the results of the treatment and prevention measures for pathological dislocation of the hip following septic arthritis in the newborns. Methods Twenty cases undergone open reduction were studied restropectively. In addition, greater trochanterplasty was penformed in 15 cases, acetabularplasty in 14 cases, greater and lesser trochanterplasty in 2 cases. Rusults A successful rate of reduction achieved in 90％ of the patients; however, central reduction was achieved in only 38.8％ . 20 patients were followed-up for 6 months to 12 years. The stability and motility of the hip gradually improved in majority of the patients. The cases with severe destruction followed by absence of femoral head and neck had unsatisfactory results. Shortening deformity were found in six cases, and subluxation, dislocation, rigidity of the hip in one case each. Conclusion The greater trochanterplasty had a good result for reduction and maintaining the position. Early diagnosis and early open drainage were key measures for prevention of pathological dislocation of the hip resulting from the acute septic arthritis in the newborn.