髋关节发育不良保守治疗后股骨头坏死的随访研究  

Management of developmental dysplasia of the hip by conservative regimen:a follow-up study on the incidence of avascular necrosis(AVN) of femoral head

作　　者：胡玲珑[1] 汪超[1,2] 赵黎[1] 李海[1] 沈品泉[1] 蔡奇勋[1] 陈秋[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿童骨科,200092 [2]浙江省台州骨伤医院儿童骨科

出　　处：《中国矫形外科杂志》2013年第3期233-237,共5页Orthopedic Journal of China

基　　金：教育部高等学校博士学科点新教师基金课题(编号:20090073120037);上海市科委医学引导类项目(编号:09411962600);上海市卫生局青年科研项目(编号:2008Y069)

摘　　要：[目的]总结采用保守治疗6～36个月龄髋关节发育不良(DDH)的随访结果,回顾分析在该治疗模式下发生股骨头缺血坏死(AVN)的相关因素。[方法]随访2007年12月～2009年12月在本院采用双侧内收肌松解、手法闭合复位、石膏外固定方法治疗有完整资料的6～36个月龄DDH患儿,治疗结果的评价采用周永德、吉士俊的方法,根据影像学表现和Bucholz-Ogden分型标准进行AVN评价。[结果]63例101髋获得随访,随访时间为2.25～4.25年,平均3.2年。优良率为80.2%,13髋发生AVN,发生率为12.8%,3髋发生再脱位,发生率为2.9%。[结论]采用内收肌松解、手法闭合复位、屈髋90°～120°外展位外固定是治疗6～36个月DDH一种良好方法,AVN的发生与患儿的脱位程度、股骨头骨化中心发育情况有关。[ Objective] To report the outcome of treatment in the developmental dysplasia of the hip （DDH） , which was performed during 6 to 36 months of age, along with the analysis for the factors in correlation of the complication of avaseular necrosis （AVN） . [ Methods] The DDH patients, who were 6 to 36 months old at the initiation of treatment in our hospital during the period from December 2007 to December 2009, were retrospectively followed and evaluated. The complete data were obtained by means of medical chart review, follow - up at the clinics and phone calls. The treatment regimen included the releasing of bilateral adductor muscle, closed reduction and cast immobilization. The treatment results were assessed with the use of Zhou - Ji classification. AVN was found and evaluated according to the radiographic presentations with the use of Bueholz - Ogden typing system. [ Results ] Sixty - three patients with 101 involved hips were followed for the period of 2. 25 to 4. 25 years with an average of 3.2 years. The excellent result was obtained in 80. 2% of the cases. AVN was found in 13 hips with the incidence rate of 12. 8%. Three hips were re -dislocated with the occurrence rate of 2. 9%. [ Conclusion] The regimen, inolqding the releasing of bilateral adductor muscle, closed reduction and east immobilization with the hip abducted just to maintain the reduction but flexed to 90 - 120 degrees, is a good option for the treatment of DDH at the age of 6 months to 36 months after birth. It was revealed that the occurrence of AVN had been correlated with the degree of dislocation and the radiographic appearance of the ossification center of femoral head.

关 键 词：髋关节发育不良 股骨头缺血坏死 屈髋外展位 石膏外固定 

分 类 号：R687.4[医药卫生—骨科学]