婴幼儿发育性髋脱位的矫形器治疗

[目的]观察探讨应用矫形器对婴幼儿发育性髋关节脱位的治疗效果。[方法]对92例155髋2岁以内婴幼儿,根据年龄、髋臼发育程度及头臼位置关系选用不同型号矫形器治疗,定期复查髋关节X线片,记录髋臼指数(AI)变化及头臼位置关系,作为疗效评定依据。[结果]随访6～52个月,平均28个月。92例155髋复位成功率:年龄≤6个月组91.01%,7～12个月组76.19%,12个月组54.16%;Ⅰ度脱位成功率83.87%,Ⅱ度脱位为84.48%,Ⅲ度脱位为54.55%,半脱位为79.16%。治疗前AI均值:成功髋30.44°±6.48°,失败髋37.58°±5.28°。无股骨头坏死病例出现。[结论]矫形器对婴幼儿发育性髋脱位有显著治疗作用,疗效与患儿初始治疗年龄、髋臼发育程度及矫形器治疗时间有密切关系。正确的矫形器佩戴方法及治疗时间直接影响髋关节复位的远期效果。     

发育性髋脱位保守治疗后股骨头坏死的分析

目的评价分析发育性髋脱位闭合复位后出现股骨头缺血性坏死的影响因素。方法随访1995年1月至2001年12月采用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗的有完整资料的6～36个月发育性髋脱位患者193例282髋,并对出现股骨头缺血性坏死并发症的10例10髋病例进行回顾性分析,比较其与复位前年龄、脱位程度、髋臼指数的关系。结果采用Salter评分标准,6～12个月组股骨头坏死2例,12～24个月组4例,24～36个月组4例。复位前髋臼指数值40。以上4例,40。以下6例。所有出现股骨头缺血性坏死的病例复位前髋关节都是Ⅲ度脱位。结论内收肌切断、手法闭合复位、改良蛙式石膏固定方法对6～36个月发育性髋脱位患者是一种有效的治疗方法,能很好的降低股骨头缺血性坏死的发生率,复位前髋臼指数值的大小与股骨头缺血性坏死的发生关系不大,但大于2cm的高度脱位是并发股骨头缺血性坏死的重要因素之一。     

18～36个月发育性髋脱位闭合复位的远期疗效评价

[目的]评估内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗18~36个月婴幼儿发育性髋脱位(developmental dislocation of hip,DDH)的远期效果。[方法]随访1993年1月~2001年12月在本院采用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗有完整资料的18~36个月DDH患儿156例232髋,其中Ⅰ度77髋,Ⅱ度95髋,Ⅲ度60髋,随访时间为5.5~14.5年,平均9.2年,并对全部病例进行影像学检查和髋关节功能评价。[结果]根据周永德发育性髋脱位疗效评价标准,本文195髋复位满意,优良率为84.05%,9例发生股骨头坏死;术前平均髋臼指数(AI):复位成功髋(35.34°±5.95°),失败髋(44.51°±5.32°),成功髋复位前AI均数明显小于失败髋均数;Ⅰ度优良率为84.41%,Ⅱ度优良率为85.21%,Ⅲ度优良率为81.67%。[结论]内收肌切断、手法闭合复位、改良蛙式石膏固定方法对18~36个月DDH患儿是一种有效的治疗方法,复位前AI值的大小对于DDH保守治疗方法的选择和远期疗效评估具有一定的指导意义,而脱位程度不是能否采用手法复位的标准。     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

目的 研究闭合复位术治疗发育性髋脱位(developmental dysplasia of the hip,DDH)的长期随访结果,分析复位后影响结果满意度的相关因素.方法 对1997至2005年发育性髋脱位闭合复位后60例患者(共77髋)进行平均4.5年的随访,总结临床记录和影像学资料,统计分析影响结果满意度的相关因素.结果 应用Sevefin影像学分级,77髋中56髋(73%)结果满意,Severin分级为Ⅰ～Ⅱ级;21髋结果为Severin Ⅲ～Ⅵ级,其中17髋行二次复位或矫形手术.29髋(38%)发生了程度不同的缺血坏死.统计影响结果满意度的相关因素发现:复位时年龄是影响结果满意度的重要因素(P＜0.05),复位时年龄越小最后结果的满意度越高;股骨头缺血坏死也和结果满意度相关(P＜0.05).结论 婴幼儿发育性髋脱位应早期治疗,以提高结果优良率.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

闭合复位治疗婴幼儿发育性髋脱位的疗效观察

Objectives To retrospectively review the results of closed reduction for developmental dysplasia of the hip (DDH), and analyze the causative for the dissatisfactory results of radiolagieal. Methods From 1997 to 2005 the results of closed reduction for DDH in 60 children (77 hips) over 4.5 years period were retrospectively reviewed. Radiological final results of the patients were evaluated with Severin classification. The causative factors made from medical records and radiographs were used to make statistical analysis. Results Seventy-three percent of the patients (56/77) had satisfactory results according to Severin classification. Twenty-one hips classed as SeverinⅢ-Ⅴ. Seventeen of the 21 hips had a reconstructive procedure. Avaseular necrosis was observed in 29 hips (38%). The most important parameters affecting the result were age at reduction (P ＜ 0. 05) and avascular necrosis (P ＜ 0.05).Conclusions In order to achieve better clinical and radioiogical results, the infants suffering from the DDH should be treated in the early stage. The postoperative avascular necrosis usually leads to poor prohnosis.     

发育性髋脱位手术并发症的原因分析

本文总结了我院手术治疗的发育性髋脱位236例280髋的临床资料,其中男77例94髋,女159例186髋,患者年龄1岁10个月～38岁,平均7岁9个月,术后随访1～11年,平均3年10个月,共有58髋发生了不同种类的并发症,包括再脱位9髋,股骨头缺血性坏死11髋,关节僵硬31髋,骨性关节炎7髋。文中对各种并发症产生的原因进行了较全面的分析。     

一次性联合手术治疗发育性髋脱位128例分析

目的：总结和探讨采用一次性联合手术治疗发育性髋脱位（Developmental Dislocation of Hip,DDH）的经验。方法：1992－2000年128例155髋手术中包括行内收肌、髂腰肌切断，髋在节切开复位，股骨旋转短缩截骨及髋臼pemberton成形术4步一次完成的联合手术。术后髋人字石膏固定3－6周。结果：术后随访1－8年，平均3．2年，优良率91％，结论：作者认为术前长时间住院牵引有利也有弊，联合手术可弥补牵引的不足甚至取代牵引，具有适应证宽，疗效肯定，并发症少，住院时间等优点。     

莎氏手术治疗发育性髋脱位术后再脱位的临床研究

以Salter手术为代表的各种髋骨、骨盆截骨术治疗发育性髋脱位（developmentaldislocationofthehip，DDH）在我国已广泛开展，但由于术式设计本身及术者技术的原因，术后再脱位时有发生。我们应用莎氏手术治疗DDH术后再脱位的患儿３１例，取得了较为满意的疗效。资料与方法一、一般资料１９８９年９月～１９９９年９月共收治DDH手术后再脱位患儿３１例。男６例，女２５例；年龄３～１２岁，平均５岁８个月。原行Salter术２６例，Pemberton术３例，Chiari术２例。其中３例在做上述手术前已行切开复位术，１例患儿曾行切开复位、股骨旋转…     

发育性髋脱位术后再脱位的三维CT分析

目的利用3D-CT影像,来探讨发育性髋脱位术后再脱位的髋臼及股骨近段的骨性病理形态改变,以分析术后再脱位的原因,从而指导和改进发育性髓脱位的治疗。方法对28例(28侧)发育性髋脱位术后再脱位患者的3D-CT影像资料进行分析,测量各参数指标,并与38例(51侧)手术成功患者术后值以及正常组对比分析,来探讨术后再脱位的原因。结果术后再脱位组患者的颈干角与正常组和手术成功组比较,均有高度显著性差异,其数值明显增大;术后再脱位组患者髋臼外上缘重型缺损者所占比例,与手术成功组比较有高度显著性差异;术后再脱位组股骨颈前倾角与正常组比较差异有显著性,而与手术成功组比较差异则无显著性。结论术后再脱位原因与股骨颈干角的角度、髋臼外上缘形态、股骨头与髋臼是否恢复同心圆复位关系等密切相关;股骨颈前倾角值比正常组偏大并非导致术后再脱位的必然因素,其术中矫正范围不能完全以正常组为标准,而应当以健侧为标准,纠正到一个比正常组略大的范围。     

经外侧髋臼成形术治疗儿童发育性髋脱位的初步报告

目的：介绍一种治疗儿童发育性髋脱位的术式：经外侧髋臼成形术。方法回顾2011年4月～2012年11月采用经外侧髋臼成形术治疗发育性髋脱位患者10例11髋,比较手术前后影像学变化,评价手术效果。结果对所有患者术前及术后一周髋正蛙位片进行分析,髋臼角术前平均为34.45°（31°～42°）,术后14.27°（9°～18°）;CE角术前平均为-85.18°（-174°～-48°）,术后52.54°（38°～70°）,Shenton线不连续10例11髋,术后均恢复连续;术前Severin分级Ⅰ～Ⅱ级：0髋,术后Ⅰ～Ⅱ级达10髋。结论经外侧髋臼成形术兼具salter髂骨截骨术和pemberton髋臼成形术的特点,优点突出,安全易操作,可用于治疗儿童中重度发育性髋脱位。     

Pavlik吊带早期治疗发育性髋脱位:现状与问题

髋关节发育不良是新生儿常见的出生缺陷,其中发育性髋脱位是其中头臼间失去正常对位关系的严重类型,其治疗的目的是获得稳定的同心圆对位,早期发现、早期治疗是取得良好预后的关键。Pavlik吊带是目前0~6个月DDH患儿首选的治疗方法。本文将介绍Pavlik吊带方法及原理、早期治疗结果、早期复位失败因素以及早期治疗失败后的治疗策略。