发育性髋关节脱位术后再脱位的原因分析与翻修策略  

Cause and revision strategy of redislocation secondary to primary surgeries for development dislocation of the hip

作　　者：吴伟平 李旭 燕华 金大地 史强 WU Wei-ping;LI Xu;YAN Hua;JIN Da-di;SHI Qiang(Department of Pediatric Orthopedics,The Third Affiliated ' Hospital,Southern Medical University,Guangzhou 510630,China;Xiangya Changde Hospital,Changde 415000,China)

机构地区：[1]南方医科大学第三附属医院广东省骨科医院,广州510630 [2]湘雅常德医院,湖南常德415000

出　　处：《中国矫形外科杂志》2019年第1期11-15,共5页Orthopedic Journal of China

基　　金：广州市科技计划项目(编号:156100081)

摘　　要：[目的]分析手术治疗发育性髋关节脱位术后再脱位的原因,探讨减少和避免再脱位的对策。[方法]2011年7月～2015年7月,本院经手术治疗发育性髋关节脱位术后再脱位患儿31例(31髋),男9例,女22例,初次手术年龄20个月～10岁1个月,平均(31.21±10.33)个月。对所有患儿进行3D CT影像检查,综合分析再脱位原因。针对具体病理进行翻修术,包括切开复位Salter截骨16髋,其中同时行股骨短缩手术者12髋;切开复位加Pemberton截骨13髋,其中同时行股骨短缩手术者11髋;切开复位加Chiari截骨者2髋。对翻修手术的效果进行临床与影像分析。[结果]再脱位原因包括:11髋内收肌紧张,8髋髂腰肌未切断,7髋关节囊内盂唇内翻,6髋内侧关节囊未彻底松解,11髋臼底脂肪纤维组织填充;10髋髋臼指数>45°,2髋后方骨质缺损。13髋股骨头缺血性坏死,4髋严重变形伴短颈,5髋颈干角>160°,7髋股骨颈前倾角>40°。31例(31髋)再手术复位成功率100%。随访25～72个月,平均(35.33±11.24)个月,末次随访时根据Mckay临床评估标准,优25髋,良4髋,可2髋,优良率93.55%。影像检查显示中心性复位29例,残留髋臼发育不良1例,新发生股骨头坏死1例。[结论]手术治疗发育性髋关节脱位术后再脱位的主要原因包括:术中关节囊及周围软组织处理不当、手术指征及术式掌握不当、手术操作不规范及年龄等因素。只有遵循个体化的治疗原则,获得术中股骨头与髋臼稳定的同心圆复位,才能避免再次脱位的发生。[Objective] To analyze the reasons of redislocation after primary surgery for development dislocation of the hips(DDH), and explore the corresponding solutions. [Method] From July 2011 to July 2015, 31 patients(31 hips) underwent surgical revision for redislocation after the primary operations for DDH in our hospital. The children, including 9 boys and 22 girls,aged from 20 months to 10 years and 1 months with an average of(31.21±10.33) months. After a thorough imaging evaluation, including 3 dimensional computer tomographic scanning, and intraoperative gross observation during revision, the reasons of redislocation were identified. Corresponding revision procedures were performed, including open reduction and Salter osteotomy in16 hips containing 12 hips simultaneously combined with femoral shortening osteotomy, open reduction and Pemberton osteotomy in 13 hips containing 11 hips concurrently combined with femoral shortening osteotomy, and open reduction and Chiari osteotomy in 2 hips. The revision consequences were clinically and radiographically evaluated. [Results] The pathology that might be related to the redislocation was of adductor tension in 11 hips, un-disconnected iliopsoas tendon in 8 hips, labrum introversion in 7 hips, inadequacy of medial capsule released in 6 hips, fat filling in acetabulum in 11 hips, acetabular index more than 45° in 10 hips, bone defect of the posterior acetabulum in 2 hips, avascular femoral head necrosis in 13 hips, shorting femoral neck in 4 hips, femoral neck-shaft angle lager than160° in 5 hips, and femoral anteversion angle lager than 40°in 7 hips. All of the 31 hips regained complete reduction after revision surgeries, with reduction rate of 100%. The patients were followed up from 25 to 72 months with an average of(35.33±11.24) months. At the latest follow up, the clinical outcomes were graded as excellent in 25 hips, good in 4 hips and fair in 2 hips with excellent and good rate of 93.50% according to Mckay.s criteria. The imaging assessment revealed concentric r

关 键 词：发育性髋关节脱位 髋臼 再脱位 翻修术 

分 类 号：R684.7[医药卫生—骨科学]