婴儿期行转子关节成形术治疗股骨头缺如的远期疗效

The long-term result of trochanteric arthroplasty for the treatment of absence of the femoral head in infancy

目的观察婴儿期行转子关节成形术治疗股骨头缺如伴病理性髋关节脱位的远期疗效。方法对 18例年龄为 11～ 30个月，平均 18.2个月、股骨头缺如伴病理性髋关节脱位患儿施行转子关节成形术，随访 5～ 16年，平均 9.25年。术前根据 Hunka X线检查方法进行病理分型 :Ⅰ型 1例、Ⅱ型 2例、Ⅴ型 15例。结果 18例中优 8例，股骨近端形态及髋关节功能接近正常，肢体平均短缩 0.25 cm；良 3例，股骨头近似球形、无颈，功能尚好，肢体平均短缩 1.5 cm；可 5例，股骨近端塑形不尽理想，髋臼覆盖不良，肢体平均短缩 2.1 cm，需再次手术治疗；差 2例，再脱位。结论在婴儿期施行转子关节成形术是治疗股骨头缺如的最佳时机，此时患儿骨组织具有较强的塑形能力，术后髋关节功能恢复良好，且可防止肢体短缩畸形。

Objective To observe the long- term result of pathological dislocation of the hip with absence of the femoral head treated with trochanteric arthroplasty in infancy. Methods Eighteen cases with absence of the femoral head and pathological dislocation of the hip treated with trochanteric arthroplasty were followed- up for 5－ 16 years, with an average of 9.25 years. The timing of the surgery was average 18.2 months(ranged from 11 to 30 months). Based on Hunka pathological classification, one case was divided as typeⅠ lesion, 2 cases as typeⅡ lesion and 15 cases as typeⅤ lesion. Results There were 8 cases in the excellent group, the morphology and function of the reconstructed femoral heads were nearly normal and the limb shortening were in an average of 0.25 cm. There were 3 cases in good group, the femoral heads were nearly ball sized and the femoral necks were absent, however, the function was good and the limb shortening averaged 1.5 cm. There were 5 cases in fair group, the plastic femoral heads were abnormal and there were acetabular dysplasia and the limb shortening averaged 2.1 cm. There were 2 cases in poor group with redislocation. Conclusion The result demonstrate that surgical treatment of the absence of the femoral head in infancy could obtain a better reconstructed hip and fair function; the shortening of the limb can also be avoided.