改良关节囊成形术在大龄儿童及青少年发育性髋关节脱位患者保髋治疗中的应用

Modified capsular arthroplasty for young patients with developmental dislocation of the hip

发育性髋关节脱位是严重的髋关节疾病之一。对于单侧髋关节脱位患者，双下肢不等长明显，不及时干预可继发骨关节炎、下腰部疼痛及脊柱侧凸等严重问题．最终需行人工全髋关节置换术；对于活动需求大的青少年患者，其假体寿命缩短，失败率高，髋关节翻修术数量相应增加。关节囊成形术使关节囊完整包裹于股骨头，并在髋臼成形后复位股骨头，可推迟或避免关节置换，且股骨头复位至真臼，降低了将来髋关节置换术的手术难度。早期关节囊成形术后股骨头坏死、关节僵硬、关节炎等并发症发生率高，该手术方式逐渐被放弃。近年来，通过结合髋关节外科脱位技术进行改良，并强调术后康复重要性，大大降低了并发症发生率，改良关节囊成形术在青少年单侧髋关节脱位患者保髋治疗中的地位越来越突出。为提高手术效果，应注重适应证的选择、严格的手术操作及合适的术后康复锻炼。

Developmental dislocation of the hip （DDH） is one of the most serious hip diseases. Patients with unilateral DDH are prone to secondary osteoarthritis, low back pain, gait disturbance and compensatory seoliosis because of the leg length discrepancy. Total hip arthroplasty （THA） is the highly effective treatment for patients with hip pain or dysfunction caused by unilateral DDH, thus decrease the demand for hip-preserving surgeries such as capsular arthroplasty which may postpone or avoid hip replacement. However, the failure rate of THA for young patients is high and the majority of young patients may require one or more revision arthroplasties throughout their lifetime. The basic principle of capsular arthroplasty is that the femoral head wrapped by capsule is placed into a newly reamed socket on the location of true acetabulum. Therefore, hip replacement for patients with previous capsular arthroplasty becomes easier and safer than primary THA. However, the early capsular arthroplasty have been abandoned due to the relatively high rates of femoral head necrosis and hip stiffness. Ganz modified the early procedure with the technique of surgical hip dislocation in 2012, and emphasized the importance of postoperative rehabilitation. The incidence of complication, therefore, decreased greatly due to the preservation of main blood supply of femoral head as well as the proper postoperative management. In order to improve the clinical outcomes of this modified procedure, the selection of indications and surgeons＇ experience should also be taken into consideration.