关节镜在小儿发育性髋关节脱位治疗中的应用  

Arthroscopic treatment for developmental dislocation of the hip in children

作　　者：王克来[1] 庄岩[1] 戴国峰[1] 刘月忠[1] 

机构地区：[1]山东大学齐鲁医院小儿外科,济南250012

出　　处：《中华小儿外科杂志》2005年第11期565-566,共2页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨关节镜在小儿发育性髋关节脱位(DDH)治疗中的应用价值.方法本组10例发育性髋关节脱位患儿,男2例,女8例;年龄8～26个月,平均13个月,单侧6例,双侧4例,共14侧髋.闭合复位外固定后再脱位4例5侧髋;闭合复位后安全角度小、不稳定4例6侧髋;闭合复位困难2例3侧髋.关节镜下观察妨碍复位的因素并清理髋臼.结果关节镜下观察到妨碍复位的主要因素有:盂唇增厚内翻5侧髋;圆韧带肥大4侧髋;髋臼横韧带增粗突出2侧髋;盂唇增厚内翻,圆韧带肥大与髋臼横韧带增粗突出同时存在3侧髋.所有病例髋臼内都有纤维脂肪组织充填.10例患儿复位外固定后髋关节位置好,CE角15.5°～18°(平均16.5°).经平均随访38个月(29～54个月)无再脱位及股骨头无菌性坏死发生.结论关节镜可直视下观察妨碍股骨头复位的因素,彻底清理髋臼,提高了复位的成功率,降低了股骨头无菌性坏死的发生率,是一种较好的微创治疗DDH的方法.Objective To investigate the therapeutic values of arthroscopy in children with developmental dislocation of the hip （DDH）. Methods The clinical data from 10 cases （male 2, female 8; aged from 8 to 26 months） with DDH treated with arthroscopy were retrospectively analyzed. Of these patients, 4 cases （5 hips） suffered from redislocation and 4 cases （6 hips） with unstable immobilization after closed reduction, and the other 2 cases （3 hips） failed to undergo the procedure of closed reduction. All pathological components （hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue） were removed using the arthroscopic procedure. Results All of these patients were followed up from 29 to 54 months （mean 38 months）. No redislocation and avascular necrosis of the femoral head was noted in these children. The center-edge angle was reduced to 16.5° （15.5° to 18°） after operation. Conclusions All the intra-articular structures in the acetabulum that impede the reduction of the femoral head can be successfully eliminated using the arthroscopic technique. The satisfactory results can be achieved in children with DDH by arthroscopic treatment.

关 键 词：关节镜 小儿 发育性髋关节脱位 股骨头复位 无菌性坏死 微创治疗 

分 类 号：R726.8[医药卫生—儿科]