小儿发育性髋关节脱位的关节镜下治疗

[目的]探讨关节镜在小儿发育性髋关节脱位（DDH）治疗中的应用价值。[方法]所有患儿经理学检查、X线及螺旋CT诊断为DDH,并一部分为闭合复位再脱位,另一部分为难复位。将所有病人随机分两组：一组经关节镜治疗,21例,男7例,女14例,左侧14髋,右侧12髋,共26髋;年龄6～30个月,平均17.4个月。另一组为对照组,经Ferguson手术,25例,男8例,女17例,左侧16髋,右侧13髋,共29髋;年龄8～32个月,平均18.9个月。两组均清除妨碍复位的因素并使关节成形,复位石膏外固定10个月。[结果]按周永德评分标准,关节镜治疗组：优10髋,良11髋,中3髋,差2髋。Ferguson手术组：优11髋,良10髋,中7髋,差1髋。两组间各级比较,统计学无显著性差异（P〉0.05）。[结论]关节镜在直视下观察并清除妨碍股骨头复位的因素,成形关节。此项技术,在一定条件下是可采纳的微创治疗DDH方法。     

关节镜治疗婴幼儿发育性髋关节脱位

目的探讨关节镜治疗婴幼儿发育性髋关节脱位(DDH)的临床疗效。方法对13例DDH患儿(17髋)采用关节镜治疗。结果患儿均获得随访,时间3~7(5.3±2.1)年。至末次随访,患儿均获得正常步态及髋关节活动度,无一例患儿出现股骨头坏死。髋臼指数由术前32.9°~51.8°(39.4°±11.3°)改善至末次随访时的19.8°~33.1°(24.8°±6.5°)(P0.001)。除1例(1髋)继发DDH外,其他患儿均获得股骨头与髋臼同心圆复位,恢复Shenton线连续性。结论采用关节镜治疗婴幼儿DDH临床疗效满意,具有创伤小、并发症发生率低等优点。     

髋关节镜辅助下小儿发育性髋关节发育不良的治疗

目的探讨关节镜辅助下婴幼儿髋关节发育不良（DDH）的治疗。方法 2007年2月至2008年7月间收治的7例DDH患儿,女6例,男1例,年龄17～41个月（平均22.7个月）。1例患儿为初诊,其余患儿均经历过手法复位及支具或石膏固定后失败。2例患儿存在双髋DDH,1侧经前期治疗后复位可,故所有患儿均只处理单侧。所有患儿术前尝试手法复位,安全角度不理想后采用关节镜下探查、清理术,术中探查发现所有患儿股骨头均脱出于髋臼,圆韧带及横韧带增生、肥大,盂唇肥厚,臼底充填纤维脂肪组织。术中清除圆韧带及臼底纤维脂肪组织,切除横韧带、成形盂唇。所有患儿经关节镜下清理后均顺利复位髋关节。外展支具固定部分负重行走半年。观察患儿术后CE角、申通氏线及有无脱位复发和并发症发生。结果 所有患儿术后髋关节对合位置较好,术前CE角-108～14°,平均（-31.1±0.6）°;术后CE角10～16°,平均（13.8±0.7）°,申通氏线连续。随访11～25个月（平均17.5个月）。随访期间,未见脱位复发,CE角无明显变化,无股骨头无菌性坏死发生。结论 对于部分保守治疗失败的患儿,髋关节内结构的异常阻碍其复位,从而影响髋臼及股骨近端发育是其重要原因。关节镜具有的微创优势,避免传统开放手术对患儿的较大创伤,且可在镜下探查妨碍复位的因素并去除,从而提高治疗成功率。     

Pavlik 吊带早期治疗发育性髋关节脱位

 目的 探讨 Pavlik吊带治疗不同类型发育性髋脱位的临床效果,并分析复位失败的原因。方法 回顾性分析 2009年 1月至 2013年 3月,初始采用 Pavlik吊带治疗髋关节脱位的 163例（195髋）资料完整且随访超过 1年的患儿资料,男 18例（21髋）,女 145例（174髋）;年龄 18~129 d,平均（65.9±20.2）d;左侧 85例,右侧 46例,双侧 32例;超声 Graf分型：Ⅲ型 165髋,Ⅳ型 30髋。根据屈髋、外展时动态超声检查示能否复位及 Ortolani试验,将髋关节脱位分为可复性及难复性两类。吊带佩戴 3周后临床查体及超声检查仍示未复位或复位但不稳定者,视为吊带治疗失败。末次随访时摄骨盆正位 X线片,并在其上测量髋臼指数,根据 T?nnis标准判断残余髋臼发育不良,根据 Salter标准判断股骨头缺血性坏死。分析年龄、性别、单双侧、脱位分类（可复性/难复性）及超声 Graf分型与吊带复位效果的关系。结果 195髋中,144髋（73.8%,144/195）经吊带治疗复位成功;51 髋（26.2%,51/195）复位失败,其中 47 髋再次行皮牵引后复位石膏固定治疗,4 例 4 髋拒绝再治疗。163 例患儿均获得随访,随访时间 12~49 个月,平均 19 个月。末次随访时,10 髋（6.9%,10/144）残余髋臼发育不良,4 髋（2.8%,4/144）发生股骨头坏死。单因素分析结果显示,复位成功率与年龄、性别及侧别无明显相关性,与超声分型（Graf Ⅲ∶Ⅳ型,79.4%∶43.3%）及脱位分类（可复性∶难复性,79.1%∶34.8%）有关。多因素分析结果显示,脱位分类（OR=6.071,P=0.000）及超声 Graf 分型（OR=4.629,P＜0.001）是影响复位成功的独立相关因素。Graf Ⅳ型且不可复性脱位仅 12.5%（1/8 髋）复位成功。结论 Pavlik 吊带是早期治疗发育性髋关节脱位有效安全的方法之一,Pavlik 吊带适用于 GrafⅢ型可复性脱位,对 GrafⅢ型难复性及Ⅳ型可复性脱位吊带复位失败率高,可尝试作为初始治疗的手段;Graf Ⅳ型难复性脱位不宜作为首选治疗方法。     

手术治疗小儿发育性髋关节脱位

目的 探讨手术治疗小儿发育性髋关节脱位的临床治疗效果.方法 小儿发育性髋关节脱位患者21例共33个髋关节作为研究对象,其中男5例7个髋关节,女16例26个髋关节.年龄为3～6岁,平均年龄为(4.12±1.23)岁.所有对象均接受pemberton截骨术和salter截骨术,并进行随访观察.结果 本组均获随访,随访时间为10～34个月,平均23个月.小儿发育性髋关节脱位患者手术后优良率为93.94％.X线结果显示,有19例达到同心圆复位,无再脱位发生,有2例患者分别发生股骨头缺血性坏死和关节僵硬.结论 对小儿发育性髋关节脱位患者,采用pem-berton髋臼截骨术和salter截骨术的改良手术有较好的临床治疗效果,值得临床推广使用.     

关节镜辅助下治疗髌骨复发性脱位

目的 探讨关节镜辅助下行髌外侧支持带松解、内侧支持带紧缩及部分加行Goldthwait-Roux(改良)术治疗髌骨复发性脱位的疗效.方法 2003年1月至2008年12月共收治78例髌骨复发性脱位患者,男23例,女55例;年龄11～45岁,平均20.3岁;平均脱位次数为5次.所有患者均在关节镜监视下行髌外侧支持带松解、内侧支持带紧缩(12例行内侧髌股韧带重建)术,其中13例加行Goldthwait-Roux术,26例加行改良Goldthwait-Roux术.观察患者的主观症状和客观体征,髌骨脱位复发情况,膝关节正位、髌骨轴位X线片,评价膝关节功能康复情况.结果 65例患者术后获19～76个月(平均47.3个月)随访,患者对治疗均满意,无再脱位.7例膝关节活动过多有酸痛感,5例膝关节有10°～15°的屈曲度减少,6例偶有髌股轻微错动感.65例患者按髌骨损伤Bostman评分:术前(18.5±4.5)分,术后(27.5±2.5)分,差异有统计学意义(t=9.223,P=0.018).按Lysholm膝关节功能评分:术前(42.3±6.1)分,术后(91.4±4.3)分,差异有统计学意义(t=46.801,P=0.026).结论 根据病情行髌骨术外侧支持带松解、内侧支持带紧缩,部分加行Goldthwait-Roux(改良)术治疗髌骨复发性脱位是一种行效的方法,且创伤小、恢复快.

Abstract：

Objective To evaluate arthroscopy-assisted release of the lateral retinaculum and reefing of the interior retinaculum for treatment of recurrent patello-femoral joint dislocation.Methods From January 2003 to December 2008, 78 cases of recurrent patello-femoral joint dislocation were treated under arthroscopy.They were 23 men and 55 women, with a mean age of 20.3 years (range, 11 to 45 years).Their recurrence of dislocation averaged 5 times.Operative release of the lateral retinaculum and reefing of the interior retinaculum were performed under arthroscopy for all the patients.Auxiliary Goldthwait-Roux procedures were conducted in addition in 13 cases, and auxiliary improved Goldthwait-Roux procedures in 26 cases.We evaluated their subjective symptoms and objective signs, recurrence of patello-femoral joint dislocation, X-ray examinations and functional rehabilitation of the knee joint during the first 3 months, and at 6 and 12 months postoperation.Results Of the 78 cases, 65 were followed up for a mean of 47.3 months (from 19 to 76 months).All the patients were satisfied with the therapeutic effect.Recurrence of dislocation was no longer observed.Seven cases experienced slight pain after excessive motion.The flexion was slightly limited in 5 cases.Six cases reported a sense of patello-femoral malposition.By the Bostman evaluation system, the 65 cases scored 18.5 ±4.5 and 27.5 ±2.5 before and after surgery respectively, showing a statistically significant difference(P=0.018).By the Lysholm evaluation system, they scored 42.3±6.1 and 91.4±4.3 before and after surgery respectively, also showing a statistically significant difference (P = 0.026).Conclusion For treatment of recurrent patello-femoral joint dislocation, arthroscopy-assisted release of the lateral retinaculum and reefing of the interior retinaculum, as well as the auxiliary Goldthwait-Roux or improved Goldthwait-Roux procedures for necessary cases, has the merits of minimal invasion and rapid recovery.     

三联术治疗发育性髋关节脱位的临床研究

自1997年9月-2002年9月在原单一手术方法(髋臼上缘截骨造盖、股骨缩短)的基础上，应用三联术(髋臼上缘截骨，股骨缩短，并将缩短的骨块直接填人髋臼上缘使髋臼成形，转子下旋转截骨)，治疗发育性髋关节脱位102例，收到满意效果，报告如下。     

关节镜辅助治疗小儿发育性髋关节脱位

[目的]介绍普通牵引床牵引双入路关节镜辅助治疗难复性小儿发育性髋关节脱位(DDH)的手术技术与临床效果。[方法] 2016年1月～2017年12月对5例(5髋)难复性小儿发育性髋关节脱位行关节镜辅助治疗闭合复位术。采用护皮膜绷带协助固定患儿双下肢于普通牵引床牵引,前外及外侧双入路观察操作,镜视下切除肥厚的圆韧带、清理髋臼底部纤维脂肪组织,盂唇内翻者行外2/3放射状切开、松解缩窄关节囊及髋臼横韧带。清理完毕后关节镜监视下手法复位,双髋人类位石膏外固定,术后6～8周更换二期石膏。[结果]全部5髋在关节镜松解下复位成功。所有患儿随访18～36个月。安全角由术前的(16.54±4.85)°增至术后的(65.98±6.56)°,差异有统计学意义(P0.05);股骨头内侧化率由术前的(65.66±20.67)%增至镜下清理后的(106.45±15.55)%,差异有统计学意义(P0.05)。髋臼角由术前的(41.66±5.27)°降至末次随访时(27.43±5.24)°,差异有统计学意义(P0.05)。末次随访时,1例患者出现Kalamchi-MacEwen分型Ⅰ型股骨头缺血性坏死,1例残留有髋臼发育不良,其他患儿骺板内无骨桥形成,股骨头形状修复满意。[结论]普通牵引床牵引双入路关节镜辅助下髋臼清理闭合复位术是治疗难复性小儿发育性髋关节脱位安全有效的方法。     

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...     

小儿发育性髋关节脱位新手术治疗方法的探讨

目的探讨一种新的治疗小儿发育性髋脱位手术方法。方法以选择性深度扩臼术并新型髋膝活动式支架治疗12名发育性髋脱位患儿,术后随访7～9年,观察疗效及并发症出现的情况。结果选择性深度扩臼术出血量小(66±7)ml,时间短(58±6)min,复位满意。术后患儿在短期内(3周左右)均可进行髋膝功能锻炼,无一例出现髋关节僵硬、术后再脱位及患侧股骨头无菌性坏死等并发症。结论新手术方法头臼复位确切、操作简单、创伤小、疗效较好、术后并发症少,是临床可选择的另一种新术式。     

发育性髋脱位早期保守治疗后残余半脱位的长期随访

目的 探讨发育性髋脱位(developmental dislocation of the hip,DDH)早期手术干预的时机与指证.方法 纳入2000年1月之前出生,经保守治疗后1年内出现残余半脱位畸形,至生长发育停止(髋臼“Y”形软骨闭合)系列骨盆正位X线片完整的DDH患儿共36例48髋.测量髋臼指数(acetabular index,AI)、Reimers指数和CE角,并观察髋臼眉弓形态.采用Severin标准,对末次随访X线片分级,Severin Ⅰ、Ⅱ级为优良,SeverinⅢ、Ⅳ级为中差,分析两组患儿在随访过程中系列X线片各指标的改变.结果 闭合复位时平均年龄1.6岁,末次随访时平均年龄13.8岁,最终18髋(37％,18/48)为Severin Ⅰ、Ⅱ级,30髋(63％,30/48)为SeverinⅢ、Ⅳ级.两组患儿3～4岁时Reimers指数(34.4％±4.5％和43.0％±4.6％)的差异有统计学意义,4～5岁时Reimers指数(29.3％±7.2％和40.0％±6.2％)及CE角(21.0°±5.5°和10.6°±5.2°)的差异均有统计学意义.3～4岁时Reimers指数＞38％(18/18,100％)、4～5岁时Reimers指数＞33％(26/30,87％)的患儿最终为SeverinⅢ、Ⅳ级;4～5岁时Reimers指数＞33％且眉弓向上倾斜(26/26,100％)的患儿最终为SeverinⅢ、Ⅳ级.结论 患儿3～4岁时Reimers指数＞38％、4～5岁时Reimers指数＞33％、眉弓向上倾斜,明显提示远期Seveing分级为Ⅲ、Ⅳ级,应考虑手术矫正,以避免和预防成年后早发性骨关节炎的发生.     

开放复位加股骨短缩术治疗小儿发育性髋关节脱位的临床研究

目的探讨开放复位加股骨短缩术治疗小儿发育性髋关节脱位（DDH）的临床疗效。方法回顾性分析本组11例（11髋）DDH患儿采用开放复位、股骨短缩术加Salter截骨术式治疗。其中男2例,女9例;左侧7例,右侧4例。患儿手术时年龄为2岁8个月～5岁3个月,平均3．5岁。按Tsnnis系统分级：Ⅲ度2例,Ⅳ度9例。术前患肢缩短1．5～3．5cm,平均2．4cm。结果患儿随访时间1～6年,平均2．8年。股骨颈前倾角术前测量30°～50°,术中皆矫正至20°左右。术前髋臼指数35°～55°,术后矫正至17°～32°。术中股骨截骨长度1．0～2．5cm,平均1．6cm。McKay评分,优7髋,良4髋。股骨头缺血性坏死1例。结论对2～6岁之间的高脱位DDH患儿,开放复位术中发现复位困难或复位后压应力大时应行股骨截骨短缩术。     

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.