发育性髋脱位术后再脱位原因探讨  

Causes of re-dislocation after open reduction for developmental dislocation of the hip

作　　者：胡月光 陈后平 张问广 任冲 侯立松 边源 吴昊 孙俊康 吴华萍 

机构地区：[1]贵阳市儿童医院骨科,563003

出　　处：《中华小儿外科杂志》2016年第11期861-866,共6页Chinese Journal of Pediatric Surgery

基　　金：贵州省卫生厅2007年度科技基金-64

摘　　要：目的探讨发育性髋脱位（DDH）手术治疗后再脱位原因和预防措施，提高DDH手术治疗效果。方法对我院2007年3月至2016年1月收治的41例经过手术治疗后发生再脱位DDH患儿的术式、X线片资料和翻修手术中的发现进行回顾性总结，X线片资料用统计学进行分析。结果发生再脱位的术式：Salter骨盆截骨术12例，Pemberton骨盆截骨术26例，骨盆联合截骨术3例，股骨粗隆下旋转截骨31例。术后应用下肢关节康复器（CPM）行功能训练开始时间：术后两周6例（2-2.5岁）、术后3-4周11例（大于3岁）。翻修手术前髋臼指数25°-27°15例、28°-32°26例，股骨颈前倾角55°-75°41例，颈干角大于150°16例，髋臼缺损11例。翻修手术中发现髋臼前缘缺损6例，后缘缺损6例，髋臼浅短21例，髋臼后外缘缺损8例。股骨头嵌于外侧5例，髂胫束紧张35例，髂腰肌腱紧张25例，髋关节囊在假臼后上部19例，关节囊后缘向内腔突出15例，髋臼横韧带紧张15例，髋臼内有瘢痕组织充填41例。翻修手术行髂胫束松解35例，髂腰肌腱松解25例，髋臼横韧带切断15例，髋臼内瘢痕组织刮除41例，髋关节囊假臼部剥离19例。骨盆联合截骨术35例，Pemberton骨盆截骨术6例。髋臼后缘植骨6例，髋臼后外缘植骨8例，股骨粗隆下旋转截骨纠正前倾角41例。翻修手术后髋臼指数小于20°-25° 37例、26°-28° 4例，股骨颈前倾角15°-25°38例、30°-35°3例。经6个月至7年的随访，发生再脱位后缘缺损1例，股骨颈前倾角35°1例），髋关节功能活动小于90° 4例，股骨头缺血性坏死表现9例，双下肢不等长4例（后期行患肢胫骨延长2例，股骨延长2例）。结论DDH手术治疗后再脱位可能原因：①髋臼缘缺损和股骨颈前倾角和颈干角过大使髋关节不稳定，病理性组织阻碍复位；②术后髋关节固定不当及过早活动髋关节。再脱位预防措施：①�Objective To explore the causes and risk factors for re-dislocation after open reduction for developmental dislocation of the hip （DDH）. Methods A retrospective study was conducted for 41 patients with re-dislocation after successful open reduction for DDH between March 2007 and February 2016. The associated factors, such as original method of open reduction, radiography （femoral neck anteversion angle, acetabular index ＆ acetabular defects） and perioperative findings, were analyzed to examine the predictors of reoperation. The mean follow-up period was 4. 5 （2-9. 5） years. Results All patients underwent reopen reduction. The original methods of open reduction for DDH were Slater＇s innominate osteotomy （n = 12）, Pemberton innominate osteotomy （n = 26）, triple pelvic osteotomy （n = 3） and subtrochanteric rotary osteotomy （n = 31）. Continuous passive motion （CPM） as functional trainings of knees and hips was applied postoperatively for 2 weeks （n = 6） and 3-4 weeks （n = 1l）. Preoperative data： acetabular index was 25-27 degrees （n = 15） and 28-32 degrees （n = 26）, femoral neck anteversion 55-75 degrees and femoral neck-shaft angle 150 degrees （n = 16）. The locations of acetabular defects were at anterior （n = 6）, posterior （n = 6） and lateral （n = 8） edges of posterior acetabulum. The methods of reopen reduction were triple pelvic osteotomy （n = 35） and pemberton innominate osteotomy （n = 6）. Bone grafting was performed for significant acetabular deficiency in posterior acetabular wall （n = 6） and lateral posterior edge （n = 8）. Subtrochanteric rotary osteotomy was performed in corrective femoral neck anteversion angle （n = 41 ） and femoral neck-shaft angle （n = 21）. There were re-dislocation （n = 2）, posterior acetabular deficiency （n = 1 ）, femoral neck anteversion angle of 35 degrees （n = 1 ）, range of motion （ROM） of hip joint function 〈90 degree （n = 4）, avascular necrosis （AVN） of the femora

关 键 词：髋脱位 发育性 修补手术 外科 髋臼 

分 类 号：R726.8[医药卫生—儿科]