发育性髋关节脱位治疗后并发症的防治体会

Understanding of Preventing and Curing Complications Showing up after Treatment of Developmental Dislocation of the Hip

目的 :本文通过对发育性髋关节脱位治疗后并发症出现的原因进行讨论分析 ,并提出防治方法 ,利于指导今后治疗 ,降低并发症的发生率。方法 :本组对 1983年以来获得随访的 40 0例 ( 5 71髋 )发育性髋关节脱位治疗后并发症进行原因分析 ,其中手法复位治疗 178例 ( 2 76髋 ) ;手术复位治疗 2 2 2例 ( 2 95髋 )。结果 :本组发生髋关节再脱位 5 3髋 ,股骨头缺血坏死 77髋 ,髋关节僵硬 42髋。 1995年以后髋关节再脱位、股骨头缺血坏死、髋关节僵硬明显减少。结论 :3岁以下患儿 ,髋臼指数 >45°、Ⅲ°以上脱位者不适合手法复位。手法复位成功者 ,铝板衣固定时间不应超过 9个月。 8岁以上患儿术后发生股骨头缺血坏死、髋关节僵硬比例增高 ,股骨短缩、早期功能锻炼、CPM可减少头坏死及关节僵硬发生。髋臼造盖术时植骨量少、植骨高度不够可引起术后再脱位。

Objective: By discussing and analyzing the reason of the occurrence of complications after treatment of developmental dislocation of the hip to put forward the preventive and curative methods, which is in favor of the treatment afterward and can decrease the incidence rate of the complications. Method: Analyzed the reason of the occurrence of complications after treatment of developmental dislocation of the hip. In this group 400 cases (571 hips) obtained following up since 1983 were included, in which 178 cases (276 hips) were carried out diaplasis treatment by hand and 222 cases (295 hips) by operation. Result: In this group the redislocation of the hip happened to 53 hips, ischemic necrosis of the femoral head happened to 77 hips and the stiffness of the hip happened to 42 hips. The occurrences of the redislocation of the hip, ischemic necrosis of the femoral head and the stiffness of the hip have decreased obviously since 1995. Conclusion: The diaplasis treatment by hand is not fit for the children younger than 3 years old and the patients whose index of the hip is more than 45° and dislocation is more than Ⅲ°. The fixing time of the aluminium plate coat should not be longer than 9 months for the patients treated with the redislocation by hand successfully. The proportion of the ischemic necrosis of the femoral head and the stiffness of the hip after operation increased in the children older than 8 years old. The shortening of the femor, early functional exercises and CPM can decrease the occurrence of the necrosis of the femoral head and the stiffness of the joint. If the amount of the bone transplanted is low and the height of the bone transplanted is not enough when build cover on acetabulum, the redislocation after operation will happen.