儿童创伤性髋关节脱位的治疗与短期随访结果:病例报告和文献回顾

Treatments of traumatic hip dislocation in children and outcomes of short-term follow-up:case reports and literature review.

目的总结分析儿童创伤性髋关节脱位的治疗与短期随访结果,并进行文献回顾。方法回顾性分析2014—2018年就诊于厦门大学附属福州第二医院的10例儿童创伤性髋关节脱位病例,10例均为后脱位。其中7例男性,3例女性,受伤时平均年龄7.9岁(2~14岁),平均随访时间20.9个月(12~35个月)。结果在后期的随访中,8例未出现髋关节疼痛,1例出现股骨头缺血性坏死、创伤性骨关节炎,1例出现坐骨神经麻痹症状。另外有1例出现髋关节间隙增宽,但后期功能恢复尚可。末次随访时根据Harris评分进行疗效等级判定,其中优6例,良2例,差2例。结论结合文献综述和本组病例,我们认为创伤性髋关节脱位在儿童中发生率较低,可见于任何年龄段,多为后脱位。损伤机制、复位时机及是否合并其他损伤等因素与创伤性髋关节脱位的预后具有相关性。在受伤后6 h内复位仍应作为THD的治疗目标,复位前后进行CT甚至MRI评估是必要的。同时,后期随访中是否发现股骨头缺血性坏死应当作为关注的重点。

Objective Traumatic hip dislocation is an orthopedic emergency caused by external forces.Due to the particularity of anatomical structure of hip joint,the incidence of traumatic dislocation of hip joint is lower in children than that in adults.Traumatic hip dislocation(THD)is often complicated by avascular necrosis of femoral head and traumatic osteoarthritis,requiring immediate and accurate evaluations and prompt reductions.Methods Retrospective analysis was conducted for 10 children of posterior THD from 2014 to 2018.There were 7 boys and 3 girls with an average age of 7.9(2-14)years at the time of injury and an average follow-up time of 20.9(12-35)months.Results At the last follow-up,eight children had no hip pain.One case presented with avascular necrosis of femoral head and traumatic osteoarthritis while another case had the symptoms of sciatic nerve palsy.Also one case of hip joint space widening recovered well in a later stage.According to the Harris score at the last follow-up,the outcomes were excellent(n=6),decent(n=2)and poor(n=2).Conclusion Combined with literature review,traumatic dislocation of the hip is less common in children and can occur at any age.Most cases developed posterior dislocation.Injury mechanism,timing of reduction and a combination of other injuries are correlated with the prognoses of THD.Reduction within 6 hours after injury should remain an objective target.CT or even MRI evaluation is necessary before and after reduction.At the same time,avascular necrosis of femoral head should be a focus of attention during follow-ups.