一次综合性手术治疗大年龄先天性髋脱位

Primary Complex Operation on the Basis of Salter Pelvic Osteotomy for the Treatment of Congenital Hip Joint Dislocation in Elder Patients

目的 :探讨 8～ 19岁的Ⅲ级先天性髋脱位的外科治疗以及需要掌握的技术环节 ,如何预防术后可能发生的主要相关并发症。方法 :5 1例 ( 5 7髋 )术前不行牵引采用切开复位、Salter骨盆截骨、股骨转子下短缩旋转截骨、股内收肌 ,髂腰肌及髋部其它挛缩软组织广泛松解的一次综合性手术治疗。对其中 13例 ( 14髋 )髋臼指数 5 5°以上者 ,在Salter截骨的同时再实施造盖。结果 :随访 14个月～ 9年 ,平均 4年 2个月。按Mckary临床评定标准 ,优良率 46髋 ( 84% )、可 6髋( 11% ) ,差 3髋 ( 5 % )。按SeverinX线片评定标准 ,优良率 44髋 ( 80 % )、可 7髋 ( 13 % ) ,差 4髋 ( 7% )。结论 :该术式是治疗大年龄先天性髋脱位的一种可靠手段。

Objective:To study the technical key points during surgical treatment of congenital dislocation of hip joint in elder patients and how to prevent complications after surgery.Method:Fifty one patients(57 hip joints) aged from 8～19 years with degree Ⅲ dislocation of hip joint were treated.No traction was done with hip joint before surgery.The procedure involves open reduction?Salter pelvic osteotomy?subtrochanteric shortening rotation osteotomy and wide ease of the adductor,iliopsoas muscle and other contracture soft tissues.Thirteen patients(14 hip joints) with acetabulum index over 55° had shelf operation during Salter osteotomy.The results after a period of 14 months to 9 years follow up(averaged 4 years and 2 months) showed that according to Mckary clinical evaluation criterion:good,46 hip joints(84%);fair,6 joints(11%);poor,3 joints(5%).According to Severin X ray film criterion:good,44 hip joints(80%);fair,7 joints(13%);poor,4 joints(7%).Conclusion:Our experience shows that the method is satisfactory for the treatment of congenital hip joint dislocation in elder patients.