发育性髋关节脱位闭合复位治疗后髋臼发育变化观察

目的：观察分析发育性髋关节脱位经闭合复位治疗后髋臼发育变化的规律以指导治疗。方法：本组对2006年以来获得随访的78例发育性髋关节脱位患儿分为大小年龄组,均给予闭合复位治疗,其中连衣挽具治疗18例;可调式铝架治疗60例,于复位前、复位后动态测量患、健侧髋关节的髋臼指数[acetabular index,AI]和髋臼深度与宽度比值[acetabular index of depth to width,AI（D/W）],并进行相关比较。结果：根据周永德发育性髋脱位疗效评价标准,治疗12个月功能恢复总优良率达88.46%。脱位髋关节经闭合复位各项指标的改变分别为：患侧AI由治疗前（33.75±4.60）°下降至（24.50±6.35）°,AI（D/W）由（12.20±4.65）%增长至（20.10±3.45）%,患侧AI下降幅度、AI（D/W）增长幅度明显快于健侧（P〈0.01）。在AI的回复过程中,大龄组和小龄组间存在明显的差别。结论：闭合复位治疗发育性髋关节脱位操作简便,对2～24个月DDH患儿是一种有效的治疗方法,治疗效果良好,其中股骨头复位是刺激AI下降和AI（D/W）增加的主要因素,在治疗后12个月内,患侧髋臼发育速度明显快于健侧。患儿年龄≤18个月为治疗发育性髋关节脱位的最佳时期。

Research on the Acetabular Development of Developmental Dislocation of the Hip Treated with Closed Reduction

Objective：To observe and analyze the law of change of acetabular development when developmental dislocation of the hip were treated with closed reduction and to guide treatment. Methods： All 78 children with developmental dislocation of hip were followed up since 2006 and divided into senior age group and low age group. They were treated with closed reduction, in which umpsuit harness 18 patients, adjustable aluminum frame 60 patients. Dynamic measurements of contra- lateral hip acetabular index [acetabular index, AII3 and acetabular depth and width ratio [acetabular index of depth to width, AI （D/W）17 were applied and compared before and after reset. Results.. According to Zhou Yongde DDH evaluation criteria, total good functional recovery rate was 88.46% at 12 months after treatment. The various indicator changes of dislocation of the hip after closed reduction treatment were as follow.. AI decreased from （33. 75±4. 60） ° to （24. 50±6. 35） °, AI （D/W） increased {rom （12. 20±4. 65）° to （20. 10±3. 45）°, AI declined and AI （D/W） growth rate of the ipsilatera were significantly faster than that of the contralateral （P〈0.01）. In reply to the AI process, there was signifi- cant difference between two groups. Conclusion： Closed reduction is a simple treatment for developmental dislocation and has good effect in treating 2 to 24 months children with DDH, in which femoral head reset is a main factor to lead AI decrease and AI （D/W） increase, the developmental rate of acetabular in ipsilateral is significantly faster than healthy side during the 12 months after treatment. Children aged ≤ 18 months is the best time to treat developmental dislocation of the hip.