改良髋臼周围截骨阶梯状植骨术治疗大龄儿童先天性髋关节脱位

目的：探讨大龄儿童先天髋脱位的手术方法。方法：采用改良髋臼周围截骨，阶梯状植骨术治疗大龄儿童先天性脱位48例62髓关节，并进行随访观察。结果：得到随访45例47髋，关节位置同心复位良好，无1例发生脱位及半脱位，关节功能恢复良好。结论：改良髋臼周围截骨阶梯状植骨术是治疗大龄儿童先天性髋关节脱位较理想的方法。     

改良Pemberton截骨治疗发育性髋关节脱位

目的探讨治疗发育性髋关节脱位(developmental dislocation of the hip,DDH)更完善的手术方法.方法 1994年3月～2002年12月,对DDH髋臼浅而小、股骨头大的48例49个髋关节,在通常术式的基础上,对Pemberton截骨术式进行改良,将截骨点上移,扩大翻转骨瓣面积;取髂骨全层骨板连带附着的骨膜植骨;增厚的关节囊制成两层,内层紧缩关节,外层稳定骨瓣.术后观察髋关节功能,X线片显示的截骨愈合程度、髋臼对股骨头包容程度及有无股骨头坏死等. 结果随访18个月～5年,按照周永德疗效评定标准,总计26～30分18例18髋,21～25分27例27髋,16～20分2例3髋,15分以下1例1髋,总优良率达93.8%. 结论改良Pemberton截骨治疗发育性髋关节脱位可增大股骨头包容,避免了传统术式减少髋臼容积的缺点,更有利于稳定关节,扩大了手术适应证.     

Dega骨盆截骨术治疗儿童发育性髋关节脱位

目的观察采用Dega骨盆截骨术治疗儿童发育性髋关节脱位的临床疗效。方法在2003年11月至2008年9月,共治疗38例发育性髋关节全脱位患儿,均为单侧,其中女34例,男4例,年龄平均3.84岁,术前股骨头脱位高度平均2.4 cm。结果术后随诊时间平均约3年,按McKay的临床评定标准,29例为优,6例为良,2例为可,1例差,出现I型股骨头缺血性坏死3例。采用Severin的评定标准,25例为优,8例为良,4例为可,还有1例因术中股骨短缩不足出现术后再脱位。结论采用Dega骨盆截骨加股骨旋转、短缩截骨术治疗儿童发育性髋关节脱位适应证较宽,手术创伤较小,配合术前牵引及术后皮肤牵引下功能锻炼,疗效满意,具有临床推广价值。     

改良Chiari截骨髋臼加盖延伸成形术治疗发育性髋关节脱位远期生物力学分析

[目的]从生物力学角度对改良Chiari截骨髋臼加盖延伸成形术和传统的Chiari截骨术治疗发育性髋关节脱位疗效进行评价。[方法]选择2006年2月~2009年5月在衡水市第四人民医院手术治疗的发育性髋关节脱位患者72例。将患者随机分为两组,试验组:38例,采用改良Chiari截骨髋臼加盖延伸成形术治疗;对照组:34例,采用传统的Chiari截骨术治疗。二组患者术前常规检查足底压力。术后5年,对患者进行远期随访,再次检查足底压力。[结果]术后5年,试验组患者患侧与健侧各足底压力指标均无统计学差异。对照组患侧部分足底压力指标与健侧仍有统计学差异。[结论]与传统Chiari截骨术相比,采用改良Chiari截骨髋臼加盖延伸成形术治疗发育性髋关节脱位,患者的足底压力更接近正常,远期效果较为满意。     

Salter截骨术与股骨近端旋转截骨治疗小儿发育性髋脱位

[目的]探讨应用Salter骨盆截骨与股骨近端旋转截骨术式治疗儿童发育性髋关节脱位。[方法]运用Salter截骨增加关节包容,截骨纠正股骨近端畸形。对16例26髋进行了联合手术。分析治疗结果。[结果]所有病例均在术后得到随访,按M ckay临床评价标准,优16髋,良6髋,中3髋,差1髋。[结论]该联合术式针对发育性髋脱位的病理,经骨盆及股骨近端截骨,获得稳定、功能良好的关节。     

髋臼周围截骨术治疗髋关节发育不良

目的 探讨应用髋臼周围截骨术治疗髋关节发育不良的初步临床结果.方法 2002年2月至2008年2月,应用髋臼周围截骨术治疗髋关节发育不良患者53例(55髋),女51例,男2例;年龄13～51岁,平均25.5岁.术前髋部疼痛史1个月～6年,平均16个月.6例曾经接受过髋部手术.术前WibergCE角为-20°～15°,平均3°.根据Tonnis分型,术前轻度关节炎16例,中度1例.外展位头臼关系基本正常,25例有Shenton线分离.前13例取髂腹股沟入路,后40例(42髋)采用改良Smith-Petersen入路.6例同时行转子部内翻截骨.结果 全部病例随访12～60个月,平均28个月.术后3个月均获骨性愈合.髋部疼痛症状明显改善或消失.Harris评分由术前平均77.4分提高至末次随访94.6分.术后髋关节活动度较术前减小,总活动度减小20°～60°,以屈曲活动为主.术后Wiberg CE角20°～50°,平均29°.5例出现跛行,主要由臀中肌无力造成,经功能锻炼后好转.18例出现股外侧皮神经损伤,2例出现骨盆环断裂,均与手术初期经验不足有关.无截骨不愈合、血管损伤、截骨进入髋关节等并发症.结论 对年龄较轻的髋关节发育不良患者,髋臼周围截骨术可获得较满意的临床结果.该术式可多维矫正髋臼畸形,髋臼截骨块血供不受影响,骨盆环的稳定性得以保存,患髋可以早期活动.     

改良Chiari截骨髋臼加盖延伸成形术治疗小儿发育性髋关节脱位58例远期疗效观察

[目的]探讨应用改良Chiari截骨髋臼加盖延伸成形术治疗发育性髋关节脱位的方法与疗效,减少再脱位、股骨头坏死等并发症的发生.[方法]1998年5月～2007年10月采用改良Chiari截骨+髋臼加盖延伸成形/联合股骨近端短缩旋转截骨术治疗小儿发育性髋关节脱位58例(63髋)为治疗组,随机选取同时期Chiari截骨术治疗小儿发育性髋关节脱位60例(60髋)为对照组.[结果]两组术后均随访5 ～ 12年,两组手术时间、住院时间、术中出血量比较无统计学意义,再脱位并发症、远期功能疗效满意度方面均有显著统计学差异.[结论]应用改良Chiari截骨+髋臼加盖延伸成形/联合股骨近端短缩旋转截骨术治疗小儿发育性髋关节脱位疗效好,容易掌握,治疗风险较低;便于在相关医疗机构推广应用.     

髋臼周围截骨术结合髋关节镜手术治疗成人发育性髋关节发育不良

目的:探讨髋臼周围截骨术（periacetabular osteotomy,PAO）结合髋关节镜手术治疗成人发育性髋关节发育不良（developmental dysplasia of the hip,DDH）的疗效。方法:2015年12月至2018年6月采用PAO结合关节囊切开术治疗DDH患者40例（关节囊切开组）,男...     

发育性髋关节脱位三联截骨术后再脱位原因分析

发育性髋关节脱位是较常见的儿童骨骼发育性疾病,大于18个月的儿童需手术矫正,术中的准确操作、术后的正确护理和功能锻炼直接影响着髋关节的功能恢复。我院小儿骨科2002年1月-2002年12月采用髋关节切开复位加股骨粗隆下缩短旋转截骨加髋臼成形术治疗发育性髋关节脱位193例（298髋）,其中12髋发生再脱位,就其原因作分析如下。1临床资料193例发育性髋关节脱位病例中,双侧髋发病者105例,单侧髋发病者88例（左侧55例,右侧33例）。随访9¹8个月,平均12个月。本组12例（12髋）手术后再脱位的患者中,女9例,男3例;年龄2¹6岁,平均5岁。     

Is varus osteotomy necessary in one-stage treatment of developmental dislocation of the hip in older children?

Purpose  Innominate osteotomy, varisation–derotation osteotomy, and shortening osteotomy are the most common surgical procedures used to achieve pelvifemoral realignment in the treatment of children over three years of age with developmental hip dislocation. It is well known that varus osteotomy can improve the acetabular index but it does have some disadvantages. The aim of this study was to discuss the results obtained with patients treated only with Salter osteotomy, derotation osteotomy, and shortening, without varus osteotomy, and to evaluate the need for varisation on the basis of these results. Methods  Between 1996 and 2001, twenty-four hips, sixteen unilateral and four bilateral, of a total of twenty patients treated with this method and available for final controls were evaluated. The study included sixteen female and four male patients with a mean age of 4 years 2 months (ranging between 2 years 10 months and 8 years). The mean follow-up period was determined as 6.57 years (range 5–10 years). McKay’s clinical criteria, Sever’s radiological criteria, and the evaluation system modified by Trevor et al. were used for evaluation of the results. Results  Based on McKay’s clinical criteria, eighteen hips (75%) were classified as type I, four hips (16%) as type II, and two hips (9%) as type III. According to Sever’s radiological criteria, thirteen hips (54%) were graded as grade I, nine hips (37.5%) as grade II, and two (8.5%) as grade III. According to the modified evaluation system of Trevor et al. the results were categorized as excellent in thirteen hips, good in nine hips, and moderate in two hips. Pre-operative mean acetabular index was measured as 37.3° (28°–50°) and early post-operative mean acetabular index as 26° (18°–38°). In the final radiological examination the mean acetabular index was measured as 18.3° and the mean CE angle as 30.1° (15°–38°). Avascular necrosis affecting the results developed in five hips. Conclusion  It is concluded that in older children with developmental dislocation of the hip (DDH) treated with one-stage combined surgical intervention, adequately stable concentric reduction can be achieved without varisation and that varus osteotomy is not always necessary.     

Unusual Kirschner wire migration as a late complication of Salter innominate osteotomy in developmental dislocation of the hip

Innominate osteotomy of Salter remains the most commonly used pelvic osteotomy for children in the age of 18 months to 6 years. Kirschner wire is inserted across the osteotomy site to fix the bone graft. We present an unusual case of migration of Kirschner wire through the abdominal region. Migration of pins to the femoral head is well-known complication. To our knowledge, this is the first case reporting migration of Kirschner wire through the abdominal region.     

骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因分析

目的 探讨骨盆Salter截骨治疗发育性髋关节脱位术后渐发脱位的原因.方法 采用骨盆Salter截骨治疗63例儿童发育性髋关节脱位.7例术后发生渐发脱位,分析其发生原因.结果 患儿均获得随访,时间12～89个月.术后发生渐发脱位7例中,3例因术后关节囊松弛,不能有效维持关节稳定性,通过佩带髋外展支具后髋关节恢复稳定;2...     

髂臼成形骨盆截骨术治疗幼儿发育性髋脱位的疗效

目的 探讨髂臼成形(Pemberton)骨盆截骨术治疗幼儿发育性髋脱位(DDH)的疗效.方法 对54例DDH患儿采用Pemberton骨盆截骨术治疗.记录临床随访结果和髋关节解剖结构参数.末次随访时,采用Mckay评估标准评价髋关节功能,采用Severin标准评价髋关节形态和复位情况.结果 单侧DDH患儿均获得9个月随...     

Subtrochanteric femoral shortening osteotomy in total hip arthroplasty for high-riding developmental dislocation of the hip

A surgical technique, which uses a transverse osteotomy, for subtrochanteric femoral shortening and derotation in total hip arthroplasty for high-riding developmental dislocation of the hip is described. Anteversion is set by rotating the osteotomy fragments, and torsional stability is augmented with allograft struts and cables when indicated. Eight patients with 9 total hip arthroplasties were followed for an average of 43 months (range, 24–84 months). Good to excellent results were obtained in 87% of patients (7 of 8). Eight of 9 osteotomies (89%) demonstrated radiographic evidence of healing at an average of 5 months. One patient had an asymptomatic nonunion of the osteotomy site but still had a good overall clinical result. Another patient suffered fatigue failure of a distally ingrown porous device, which necessitated revision total hip arthroplasty 18 months after surgery. Subtrochanteric osteotomy in total hip arthroplasty for developmental dislocation of the hip allows for acetabular exposure and diaphyseal shortening while facilitating femoral derotation. Furthermore, proximal femoral bone stock is maintained and some of the potential complications of greater trochanteric osteotomy may be avoided.     

Pemberton髋臼成形术治疗发育性髋关节脱位

目的：探讨分析Pemberton髋臼成形术在发育性髋脱位的治疗上具有哪些优势。方法：采用Pemberton髋臼成形术治疗儿童发育性髋脱位106例116髋,男19例29髋,女87例87髋。左侧46髋,右侧50髋,双侧20髋。年龄18个月～13岁,平均7岁3个月,其中18个月～6岁99髋,7～13岁17髋。116髋均采用Pemberton髋臼成形术或内收肌、髂腰肌切断加Pemberton髋臼成形术加转子下股骨短缩、旋转截骨术。95髋单纯行Pemberton髋臼成形术,余21髋行全套手术。双侧髋脱位患儿均先做一侧,1年后再做另一侧,同时将第1次手术股骨内固定钢板取除。结果：病例随访时间2～10年,平均6年。按照Mullerh和Seddon标准进行功能评定,优67髋,良34髋,可10髋,差5髋,优良率87%。结论：Pemberton髋臼成形术适用于多个年龄段的儿童发育性髋脱位患者,疗效肯定,在发育性髋脱位的治疗中占有重要地位。     

Steel三联截骨治疗6～9岁儿童先天性髋脱位

目的　评价Steel三联截骨手术疗效。方法　对 5例 6～ 9岁、髋臼指数平均为 4 4°的患儿行Steel三联截骨 ,对其影像学、临床结果及满意率进行随访。结果　髋臼指数平均矫正至 2 1°,疼痛和跛行好转 ,没有发生股骨头无菌性坏死加剧。结论　Steel三联截骨对于治疗髋臼指数为 4 5°左右患儿 ,是一种安全有效的手术。     

Salter截骨联合股骨转子下截骨对髋关节发育的影响

目的探讨Salter截骨联合股骨转子下截骨对髋关节发育的影响。方法对51例（59髋）发育性髋关节发良不良行Salter截骨联合股骨转子下旋转、短缩截骨治疗。测量术前、术后X线片臼头指数、CE角、髋臼指数、患、健侧股骨头骨化中心直径比率（FHDR）,比较术前、术后变化。结果随访1～5年,经Salter截骨联合股骨转子下旋转、短缩截骨治疗后,臼头指数、CE角、髋臼指数及患、健侧FHDR都有明显改善,尤其是在术后2～3年变化最为显著。疗效：优66.1%（39/59）,良27.1%（16/59）,可6.8%（4/59）,优良率93.2%。结论Salter截骨联合股骨转子下截骨是一种早期治疗发育性髋关节发育不良疗效良好、可靠的手术方法。     

ZMR modular system arthroplasty for correction of Putti's osteotomy in congenital inveterate hip dislocation

We report the case of 76-year-old woman operated in 1952 for a congenital inveterate dislocation of the left hip with a Putti's osteotomy and then treated in our institute for revision with correction osteotomy and hip arthroplasty using the modular ZMR system. With this surgical operation, the normal anatomy of the hip was restored. In fact, the articulation was again in correspondence of the true acetabulum, the femoral axle was corrected and the length discrepancy of the limb was reduced. The arthroplasty has given a stable neo-articulation and the use of the modular ZMR femoral system permitted synthesis of the osteotomy without any additional osteosynthesis devices. Received: 16 January 2003, Accepted: 28 January 2003 Correspondence to: M. Corbella     

成人发育性髋关节脱位股骨解剖参数测量

目的分析成人发育性髋关节脱位患者股骨髓腔解剖形态参数变化,为临床手术治疗提供理论基础。方法收集DDH病例43例53髋,其中女31例,男12例。采用Crowe分型,其中Ⅰ型20髋（37.7%）、Ⅱ型19髋（35.8%）、Ⅲ型7髋（13.2%）、Ⅳ型7髋（13.2%）。Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别对应Ⅰ、Ⅱ、Ⅲ、Ⅳ组。分别进行下肢全长DR影像学（正侧位）及股骨CT三维重建检查并与正常对照组比较。结果 DDH各组间患者股骨形态相似,股骨峡部平均位于小粗隆下115 mm处。DDH组股骨髓腔宽度明显小于对照组。DDH组髓腔张开指数相似,多表现为锥形髓腔。DDH组股骨头中心高度明显低于对照组。DDH组II型、Ⅲ型、Ⅳ型颈干角和对照组相比明显增大。所有DDH组与对照组相比前倾角变大。结论发育性髋关节脱位患者其股骨髓腔形态变异较大,尤其是CroweⅢ、Ⅳ患者。