8～25岁人群发育性髋关节完全脱位的非关节置换手术

Nonarthroplasty methods for developmental dysplasia of the hip with complete dislocation at the age of 8-25 patients

8～25岁人群的发育性髋关节完全脱位患者临床治疗困难.虽然全髋关节置换术可明显改善关节功能,但常有很高的失败率.髋关节融合术,术后关节稳定,止痛完全,手术费用低,且能恢复体力劳动,不失为一种有价值的治疗方法.Ganz等将Colonna手术进行了改良,描述了一期进行“外科脱位”和关节囊成形的方法,这种方法可使股骨头坏死率、关节僵硬和后发的再脱位率得以降低,能够明显缓解疼痛,改善髋关节功能,推迟髋关节置换手术时间.骨盆支撑截骨术,Ilizarov将骨盆补充支点支撑截骨术与股骨延长术联合起来重建青少年髋关节,既保留了髋关节,同时恢复双下肢长度,可明显改善步态,对严重脱位、病损的青少年髋关节提供了有效的治疗方案.股骨头颈切除术可以使90％的先天性髋关节发育不良患者获得无痛的假关节,但目前只用作挽救性手术.从检索的文献看,只要掌握好适应证和相应的手术技巧,这些手术都可获得不错的临床效果.

It is a tough challenge treatment of complete dislocation from developmental dysplasia of the hip at the age of 8-25 patients.Although the procedure of total hip arthroplasty （THA） can improve joint function significantly,the failure rate still remains high.Hip arthrodesis remains a sensible and safe option.A stable and painless hip joint can be obtained without multiple operations.Ganz et al.had described a modified Colonna capsular arthroplasty and surgical hip dislocation with well joint functions,radiographic findings and the less complications of the femoral head osteonecrosis.There is a obvious advantage in postponing THA,and subsequent THA could be technically easier and safer in a dislocated hip.The procedure of pelvic support osteotomy,which is proposed by Ilizarov,combined two steps of femur osteotomy and femur lengthening,provides an effective treatment option for adolescent hip dysplasia or dislocation.By this procedure,the hip could be reserved,the limb length recovered and the gait improved significantly.Resection arthroplasty is a reliable method,by which 90% dysplasia patients received a painless joint and good functional outcomes.In view of certain drawbacks,it is used only as a salvage operation currently.This article reviews some alternative nonarthroplasty methods for developmental dysplasia of the hip with complete dislocation.Good clinical results can be obtained through strict indications and nice surgical skills.