幼儿发育性髋脱位78例手法复位随访报告

目的通过对18个月以下与18。36个月两组髋脱位手法复位后髋关节形态发育情况进行回顾性研究，探讨18个月以上髋脱位手法复位的可行性。方法收集2003年1月至2007年12月，在复旦大学附属儿科医院接受内收肌切断、手法闭合复位、改良蛙式位（或蛙式位）石膏及外展支架固定治疗的36个月以下患儿78例（97髋），根据复位时年龄分为两组：〈18个月组与≥18个月组（18～36个月）。通过骨盆平片上髋臼指数、髋关节内侧间隙、股骨头骨骺核、股骨头中心距离差及沈通线结合股骨头缺血性坏死与残余髋臼发育不良分别对手法复位后6、12、24、36个月髋关节形态变化进行复位后平均25．2（6～60）个月的随访观察。结果手法复位后髋臼指数及髋关节内侧间隙下降程度组间差异无统计学意义（P值分别为0．45，0．57，α=0．05）；股骨头骨骺核发育情况组间差异无统计学意义（P=0．2，α=0．05）；股骨头中心距离差下降水平组间差异亦无明显统计学意义（P=0．1349，α=0．05）；沈通线在两组手法复位后都表现出一定的不稳定性：由复位前不连续，到复位后6个月支架拆除后连续，随着下地行走又欠连续。18～36个月组发生股骨头缺血性坏死率稍低于〈18个月组（P=0．04，α=0．05），而残余髋臼发育不良率前组高于后组（P=0．01，α=0．05）。结论18个月以上发育性髋脱位手法闭合复位治疗仍然可行。

A follow-up analysis of the effects of manual reduction in 78 children with developmental dislocation of the hip

Objective To retrospectively study the morphological development of hip joints after manual reduction in children with developmental dislocation of the hip （ DDH ） under 18 months and from 18 to 36 months respectively, and to investigate the feasibility of manual reduction in children with DDH over 18 months. Methods 78 patients （ 97 hips ） under 36 months received adductor tenotomy, closed manual reduction, modified frog-position （ or frog-position ） plaster fixation and external device fixation in Children＇s Hospital of Fudan University from January 2003 to December 2007. According to their ages when reduction, the patients were classified into 2 groups, under 18 months and older than or equal to 18 months （ from 18 to 36 months ） respectively. The morphological development of hip joints was observed in 6, 12, 24 and 36 months after manual reduction based on X-rays, including the acetabular index （ AI ）, medial joint space （ MJS ）, ossific nucleus （ ON ） of the femoral head, center-head distance discrepancy （ CHDD ） of the femoral head and Shenton＇s line, together with the avascular necrosis （ AVN ） of the femoral head and residual acetabular dysplasia （ RAD ）. The average duration of follow-up was 25.2 months （ range; 6-60 months ）. Results There were no statistically significant differences in the changes of AI, the decreasing degree of MJS, the developmental status of ON of the femoral head and the decreasing degree of CHDD after manual reduction between the 2 groups （ P=0.45, 0.57, 0.2, 0.1349, α=0.05 ）. Shenton＇s line became unstable after manual reduction in both groups, from discontinuousness before reduction, and then continuousness 6 months after the removal of support, to discontinuousness again when children began to walk, while the ratio of AVN of the femoral head was slightly lower in the group from 18 to 36 months （ P=0.04, α=0.05 ）, and the ratio of RAD was higher than that of the group under 18 months （ P=0.01, α=0.05 ）. Conclusions Closed manual reduction is still feasible in children with DDH over 18 months.