摘要
[目的]探讨术前不牵引用组合性手术治疗年长儿先天性髋关节脱位(CDH)的治疗效果。[方法]选择28例CDH,男9例,女19例,双髋脱位4例,共32个髋关节。年龄7～13岁,平均9.8岁。术前股骨头上移1.2～5.0cm,平均3.1cm,髋臼指数38～62°,平均46°。应用组合性手术方法,术中先松解股内收肌,再取SmithPeterson切口,充分剥离松解髂骨内外板肌肉,“Z”形延长腰大肌,其中股骨必须短缩、旋转截骨,先用组合式外固定器固定截骨断端,盐水冲洗髋臼,将股骨头复位,这样可以方便测量、矫正和调整股骨上段的角度,保留前倾角20°,颈干角130°左右,股骨截骨端再上钢板固定,但外固定仍保留。髋臼顶强力造盖,关节囊“7”形切开和正确关闭,术后患肢持续牵引4～6周,早期活动髋关节。[结果]术后随访2～6a5个月,平均3.8a,优14髋,良9髋,可7髋,差2髋,优良率71.9%。[结论]术前不牵引手术治疗年长儿CDH,正确选择手术指证,应用组合性手术,术后持续牵引下早期活动髋关节,可获得较好效果。年长儿CDH复位手术后,亦为中年后需施行全髋关节置换者创造近似正常的解剖条件。
[ Objective] To explore the outcome of combined surgery for the treatment of congenital dislocation of the hip in elderly children without preoperative traction. [ Method] A total of 28 patients with congenital dislocation of the hip, male in 9 and female in 19, bilateral dislocation in 4, total to 32 hips, aged from 7 to 13 years with an average of 9. 8 years, were treated surgically without preoperative traction. During the operation, the adductor was released, then, Smith-Peterson incision was made. Muscles were stripped out completely from the inner and outer table of the ilium, “Z” lengthening of iliopsoas tendon, subtrochanteric shortening and rotation of the femur were performed. The broken end was fixed with an external fixation frame transitorily, then the femoral head was reduced into the primary acetabulum, the broken ends were realigned to maintain 20 degrees anteversion angle and 130 degrees collodiaphyseal angle, plate and screw fixation was completely. Acetabular reconstruction and capsule suture were conducted correctly. Postoperatively, traction and early motion of affected limb were applied. [ Result] The patients were followed up from 2 years to 6 years and 5 months with an average of 3.8 years. Excellent outcome obtained in 14, good in 9, fair in 7 and poor in 2 hips, the satisfactory rate was 71.9%. [ Conclusion] Without preoperative traction, combined procedure for the treatment of congenital dislocation of the hip in elderly children, with continuous postoperative traction and early affected hip motion can achieve satisfactory outcome.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2005年第15期1152-1155,共4页
Orthopedic Journal of China
关键词
术前
关节牵引
手术治疗
儿童
先天性髋关节脱位
股骨头复位
Elderly children
Congenital dislocation of the hip
No preoperative traction
Combined surgery
Postoperative traction
