大龄儿童先天性髋脱位术后并发症的防治

Prevention and Management of the Postoperative Complications in Older Children with Congenital Dislocation of Hip

目的 :探讨大龄儿童 (2 3例 2 7髋 )先天性髋脱位术后并发症的防治。方法 :采用髂腰肌切断 ,髋臼加深 ,髋臼成形 ,股骨粗隆下截骨术。结果 :随访平均 4年 3个月 ,优良率 89% ,并发股骨头坏死 1例 ,关节僵硬 2例。结论 :解决骨性阻挡、软组织挛缩和颈干角前倾角是预防术后再脱位的关键 ;头坏死的预防术中采用短缩股骨和彻底松解挛缩的软组织 ,术后关节僵硬的防治应用无创操作 ,保护关节软骨面 ,术后牵引早期练习伸展功能 。

Objective:To study the prevention and management of the operative complications in older children with congnital dislocation of hip.Methods:There are 27 hips in 23 children.The average age was 10 years and 5 months.The open reduction,incision of iliopsoas,deeping of acetabulum,acetabuloplasty and shortening,derotational and adductire subtrochanteric osteotomy of femur were performed.Results:The average duration of follow_up was 4 years and 3 months.Twenty_four hips(89%) had a good or excellent result.The complicalions included one case of necrosis of femoral head,and 2 cases of stiffness of hip.Conclusion:The key to prevent from redislocation is the usage of bone obstruction.The second is the release of soft tissues contracture.The third is to anteverted angle and neck_shaft angle of the femur correct.To prevent necrosis of the femoral head the contracted soft tissues around the hip should be released thoroughly and the femoral shorting was performed during operation.To prevent postoperative stiffness of hip,the operator must follow the nontraumatic operative technique and pay attention to the protection of cartilage surface during operation.Early functional exercises are effective to avoid stiffness of hip.Children with stiffness can be managed with manual mobilization of hip under general anesthesia.