幼儿期先天性髋脱位的有限制动治疗

Limited Immcblilization in the Treatment of Congenital Dislocation of Hip in Young Children

先天性髋脱位的治疗近年来在切开复位手术方法上有许多新的发展并取得较前改善的治疗效果,但术后仍有种种不尽满意的结果,如关节活动受限甚至僵硬、半脱位或再脱位、以及股骨头骺缺血性坏死等,虽可再行补救治疗但效果仍不满意.故至今国内外对早期采用闭合复位治疗先天性髋脱位的方法仍极重视.

The traditional method of immobilization following close reduction of the congenital di-slocation of hip is keeping the hip strictly immobilized with the trunk and both lowerli-mbs in a plaster as Lorenz's frog-leg cast or Lange's hip spica. It would make the patient feel dull and would hinder the development of the affected hip. As the development of the hip joint depends on the active movement of the femoral head in the socket, active move-ment after the reduction should be stared ea-rlier. In our series, 171 hips in 124 cases were treated by limited immobilization mehtod after close reduction with good results. It has the advantages as follows: 1. While it keeps the reduction stable as the conventional strict immobilization does, it allows, to a certain extent, the patient to sit up, lie down, standing up, and even crawl around with the plaster on. 2. As in this method, it lea-ves the hip outside the plaster, the femoral head will be better palpable and a clearer x-ray film can be obtained for check-up. In ad-dition, there is less chance of spoiling the cast due to urine soiling and little possibility of developing pressure sores in the lumbo-sacral region. No special orthopedic table is required for the application of this kind of plaster cast. Soft tissue contracture due to strict immobilization can also be avoided. On all but a few cases, the procedures were performed in the out-patient clinic. The operation time is rem-arkably shortened and the plaster used is much less, so that this operation would be more effective. Correction of the shortness and co-ntractures of the muscles of hip region can release the tension of hip joint, and, in turn, avascular necrosis of the femoral head can be mostly avoided. Since we made the release op-eration a routine procedure, the incidence of avascular necrosis has dropped from 40% to 4%, and the success rate comes up to 98. 84%.