关节镜辅助治疗幼儿发育性髋关节脱位长期随访报告  

A Long-term Follow-up of Arthroscopic-assisted Surgery for Developmental Dislocation of Hip in Infants

作　　者：徐会法[1] 黄鲁豫[1] 雷伟[1] 沙佳 李超[1] 徐超[1] 严亚波[1] 李天清[1] 张春礼[1] 

机构地区：[1]第四军医大学附属西京医院骨科,西安710032

出　　处：《中国微创外科杂志》2017年第11期1030-1034,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金资助项目(项目编号:81171735)

摘　　要：目的探讨髋关节镜辅助治疗小儿发育性髋关节脱位(developmental dislocation of the hips,DDH)的临床效果。方法 2005年1月~2010年12月采用髋前侧及大粗隆前上入路髋关节镜技术完成16例(17髋)关节镜下增生滑膜刮除,股骨头圆韧带切除,髋臼底脂肪组织清理,髋臼横韧带松解,盂唇成形术,术毕髋屈曲外展位管型石膏外固定。术后3、6、9、12个月进行随访,随访12个月时,如果髋臼角>25°二期行髋臼囊外截骨成形、股骨旋转(内翻、短缩)截骨等治疗。随访1年后每6个月随访1次,测量患儿骨盆髋臼角并进行Mckay和Severin评分。结果平均手术时间30.2 min(22~36 min),术中出血平均13.8 ml(10~25 ml),平均住院4.2 d(3~5 d)。16例(17髋)随访60~132个月(中位数91个月),按Mckay标准,优16髋,良1髋,优良率100%,按Severin标准,Ⅰ级13髋,Ⅱ级2髋,优良率88.2%(15/17)。结论髋关节镜技术可以使髋关节有效复位、刺激髋臼软骨发育,必要时配合行二期髋臼囊外截骨成形、股骨截骨(旋转、内翻、短缩)是治疗年龄<18个月DDH的有效方法。盂唇外2/3切开的手术方式,保留内缘完整,能有效防止术后再脱位。Objective To investigate the clinical effects of arthroscopic-assisted treatment of irreducible developmental dislocation of the hip（DDH）. Methods Arthroscopic-assisted surgeries were performed in 19 infants（21 hips） under the age of 18 months between January 2005 and December 2010. Anterior and antero-superior greater trochanter approaches were used in these operations,during which the synovial membrane was resected,the femoral head ligamentum teres was excised,the pulvinar was removed,the transverse acetabular ligament was released,and the labrum was fixed. Spica cast and abduction splint were applied for3 months postoperatively. The follow-ups were conducted on the 3 rd month,6 th month,9 th months and 12 th month postoperatively.During the 12 th month ＇s follow-up,a secondary treatment such as acetabuloplasty and/or femoral osteotomy（shortening and derotation） was applied if the acetabular angle was greater than 25°. After 1-year follow-ups,all the children were followed up every half a year to measure the changes of pelvic acetabular angle that were evaluated according to the Mckay and Severin standards.Results All the children were treated with an average operation time of 30. 2 min（range,22-36 min）,average intraoperative blood loss of 13. 8 ml（range,10-25 ml）,and average lengths of hospital stay of 4. 2 days（range,3-5 days）. Follow-ups were carried out for 60-132 months（median,91 months） in 16 children（17 hips）. According to the Mckay standard,there were 16 and 1 hips rated excellent and good,with an excellent-or-good rate of 100%. According to the Severin standard,there were 13 and 2 hips rated grade Ⅰ and Ⅱ,with an excellent-or-good rate of 88. 2%（15/17）. Conclusions Arthroscopic-assisted treatment is an effective way to the reduction of the irreducible hip and can promote the development of the acetabular cartilage. Combined with acetabuloplasty and/or femoral osteotomy,if necessary,it is an alternative for DDH under the age of 18 months. Posterior 2/3 of outer

关 键 词：髋关节镜 发育性髋关节脱位 髋臼截骨术 

分 类 号：R726.8[医药卫生—儿科]