髋关节外科脱位技术在髋关节手术中的应用

Surgical hip dislocation in the treatment of various hip surgeries

目的观察髋关节外科脱位（surgical hip dislocation,SHD）技术在髋关节手术中的应用效果,探讨与临床意义有关的影响因素。方法回顾分析2008年2月至2013年8月,29例患者应用SHD技术进行手术,得到全程随访19例,随访时间11-46个月,平均28个月。术前诊断髋关节撞击综合征8例,股骨头坏死继发髋关节撞击征3例,髋关节良性肿瘤5例,扁平髋畸形（Perthe’s病后遗畸形）3例,所有病例术前有明显的关节疼痛,关节活动障碍等症状,影像学提示关节畸形。本组年龄16-55岁,平均31.2岁。末次随访时行髋关节X线摄片评估股骨头缺血坏死情况及YHS评分（Non-Arthritic Young Hip评分）评价髋关节功能变化,比较手术前后结果,并进行统计学分析。结果平均手术脱位时间32.6 min,术中失血353.43 ml。所有病例髋关节疼痛均有不同程度减轻和关节活动度的提高,髋关节功能平均YHS术前评分（49.42±7.73）分,术后（83.52±10.19）分。改良YHS评分满意度评价优5例（26.3%）,良12例（63.2%）,可1例（5.3%）,差1例（5.3%）。大粗隆截骨部位均愈合良好,无股骨头坏死及股骨粗隆间骨折并发症。结论 SHD技术可全方位显露髋关节包括髋臼和股骨侧的所有关节和非关节头颈交界区,不影响股骨头主要血液供应,是全面进入髋关节内部进行髋关节手术的良好方法。

Objective To analyze the clinical and radiographic results of surgical hip dislocation（ SHD） in the treatment of various hip surgeries, and to evaluate the influence factors of the clinical outcomes. Methods From February 2008 to August 2013, 29 SHD surgeries were performed. Nineteen patients were followed up with the average of 28 months（ range： 11- 46 months）. Primary diagnoses of the hip abnormalities： femoracetabular impingement（ FAI） in 8 cases, FAI and avascular necrosis of the hip（ AVN） in 3 cases, hip benign tumors in 5 cases, Perth＇s disease in 3 cases. All patients had the symptoms of the hip pain and the dysfunction of the hip. Radiographs indicated the deformity. The mean age was 31.2 years（ range： 16- 55 years）. In the latest follow-up, the hip X-ray was applied to evaluated the femur head avascular necrosis and Non-Arthritic Young Hip Scores（ YHS） was applied to evaluate the hip functions. Results preoperatively and postoperatively were compared and analyzed by statistics. Results The average time of the SHD was 32.6 min and the bleeding volume was 353.43 ml. All patients had some degree of the pain relief and increased range of motion. The mean YHS improved from（ 49.42 ± 7.73） to（ 83.52 ± 10.19） points. The modified YHS satisfactory scores showed excellent in 5 cases（ 26.3%）, good in 12 cases（ 63.2%）, fair in 1 case（ 5.3%） and poor in 1 case（ 5.3%）. There were no non-unions of the trochanteric osteotomy sites, any signs of AVN, or inter-trochanteric fractures. Conclusions SHD can be used to treat a variety of hip joint abnormalities with good view of the hip joint, and no disturbance of the blood supply for the femoral head.