髋关节三线诊断婴儿发育性髋关节脱位的意义

目的 探讨髋关节三线测量在婴儿发育性髋关节脱位早期诊断中的价值.方法 应用传统的体检方法,对180例疑诊者,摄双髋正位X线片,除众所周知的Shenton氏线、CE角等指标外,以股骨干骺端中点为起点,分别至髋臼外上缘、下缘、中心做连线,然后对此三线进行测量比较.结果 本组180例,单侧髋关节脱位122例(122髋),两侧髋脱位58例(116髋),总计238髋.通过髋关节三线测量,238髋此三线均不等长,确诊为DDH.对122例单侧髋脱位者的正常侧测量,120髋(98.3%)显示三线等长.同时对闭合复位欠佳者,此关节三线显示也不等长.结论 髋关节三线的定位都是骨性标志,清晰可鉴,定位准确,操作简单.髋关节三线测量,是婴儿时期诊断DDH一种比较准确的方法,特别在股骨头骨骺未出现前的小婴儿,更具有一定的特异性,是诊断DDH的可靠依据.另外对治疗中的婴儿,髋关节三线测量也是确定髋关节是否达到同心圆复位的一种有价值的参考指标.     

学龄儿童发育性髋关节脱位术后关节僵硬的前瞻性研究

目的探讨学龄儿童发育性髋关节脱位术后关节僵硬的原因。方法似设手术后创伤性炎症反应是引起学龄儿童发育性髋关节脱位术后关节僵硬的一个重要原因。本院2003年1月至2008年1月收治6岁以上发育性髋关节脱位患儿（Tonnis分级Ⅳ°）41例（64髋）,年龄6～12岁,平均年龄8．2岁。均行髋关节切开复位,股骨、骨盆截骨术。采取前瞻性随机对照方法,分为研究组与对照组,研究组25例（39髋）,其中双侧14例;男4例,女21例;对照组16例（25髋）,其中双侧9例;男3例,女13例。术前均不做牵引,手术由同一主刀医生和相同手术组成员完成。研究组术后应用激素（地塞米松）和布洛芬5d。术后两组均予石膏固定6周,定期检查髋关节活动范围、骨盆及股骨近端截骨愈合速度与质量。结果所有病例均获随访,随访时间10个月至5年,平均32个月。疗效评价采用Mekay临床髋关节功能评定标准。研究组优5例7髋,良15例24髋,可3例5髋,差2例3髋;对照组优2例3髋,良6例10髋,可4例6髋,差4例6髋。两组各有1例1髋出现股骨头坏死。研究组髋关节轻度僵硬5例8髋,中度僵硬2例3髋,重度僵硬1例1髋;对照组髋关节轻度僵硬4例7髋,中度僵硬3例5髋,重度僵硬2例3髋;两组比较,差异有统计学意义（P〈0．05）。结论手术后创伤性炎症反应是引起学龄儿童发育性髋关节脱位术后关节僵硬的一个重要原因。术中尽量减轻创伤、术后短期使用地塞米松及非甾体抗炎药物能减轻手术后创伤性炎症反应,减少术后髋关节僵硬的发生。     

新生儿髋关节筛查资料分析

目的 探讨超声及临床髋关节检查在新生儿发育性髋关节发育不良（DDH）早期筛查中的意义.方法 采用前瞻性的方法,分两阶段对我院2011年8月1日至2013年3月29日出生的新生儿分别进行髋关节临床检查和超声检查,并对筛查结果进行分析.第一阶段为2011年8月1日至2013年1月29日,筛查出生3 ～ 10天的新生儿,了解我院新生儿DDH的患病率、DDH发生的高危因素,以及髋关节超声筛查和临床物理检查两者之间的吻合度等.第二阶段为2013年1月30日至2013年3月29日,对初诊与复诊的一致性及灵敏度和特异度进行调查.结果 第一阶段共筛查5193例新生儿,临床髋关节检查阳性616例（11.86％）,超声检查阳性556例（10.71％）.男、女超声阳性率分别为6.41％和15.78％.臀位及羊水量少的新生儿超声检查阳性率分别为10.55％和13.00％.男、女左、右髋超声分度比较和男、女左髋、右髋、双髋超声检查比较显示,女婴、臀位、羊水量少、右髋发生DDH的风险高,差异有统计学意义（P＜0.05）.第二阶段共筛选出符合超声初查和复查双条件的新生儿108例,初诊与复诊结果差异无统计学意义（P＞0.05）.ROC曲线下面积为0.675（95％ CI：0.183～1.000）.阳性预测值5.88％,阴性预测值98.90％.灵敏度及特异度的95％可信区间分别为50.00％ （95％ CI：1.26％ ～ 98.70％）,84.90％（95％ CI：76.60％ ～91.10％）.结论 超声进行新生儿髋关节DDH检查排除性诊断的意义大.运用髋关节临床及超声检查筛查新生儿DDH简便、安全,可早期发现可疑及异常病例,有利于门诊随访和早期干预.     

发育性髋脱位髋臼前倾的CT评价及意义

目的 通过比较二维CT与三维CT对发育性髋脱位髋臼前倾的测量结果,来选择更准确的测量方法,明确髋臼前倾的程度,以指导治疗.方法 应用二维CT和三维CT对66例(132髋)发育性髋脱位患儿的髋臼前倾进行测量.男13例,女53例;平均年龄35.4个月(4～132个月).左侧脱位24例,右侧25例,17例为双侧脱位.单侧发病患儿的49个未受累髋作为对照.结果 全部132髋,二维CT测量结果为16.69°±4.55°,三维CT为15.91°±5.24°,P<0.05;两种测量方法间有明显的相关性,γ=0.720,P<0.001.正常髋臼前倾的三维CT测量为1 1.43°±3.82°,脱位侧为18.55°±4.04°,差异有统计学意义,P<0.001.在脱位髋中,年龄与髋臼前倾呈显著的正相关,γ=0.597,P<0.01.结论 三维CT对髋臼前倾的测量更为准确;脱位侧的髋臼前倾较正常平均增加约7.12°,且随年龄的增加而增加,但变异范围较宽;在行髋臼矫形术或术前手术模拟时,应利用3D-CT对髋臼前倾进行个性化的评价.     

18个月到3岁发育性髋关节脱位患儿初次开放复位股骨截骨与不截骨近期疗效的比较研究

目的 探讨股骨是否截骨对1 8个月～3岁儿童发育性髋关节脱位(developmental dislocation of the hip,DDH)开放复位手术治疗的近期疗效有无影响.方法 回顾性研究2010年1月至2013年12月间在国内8家单位行开放复位手术治疗的18个月～3岁的67例DDH患儿中,股骨截骨组(41例)与股骨不截骨组(26例)的近期疗效有无差异,评估术后髋臼指数(acetabular index,AI)变化,股骨头缺血性坏死(avascular necrosis,AVN)率及髋关节再脱位率有无差异.结果 股骨截骨组41例,平均年龄(2.27±0.46)岁;术后2年内复查X线发生AVN 5例,均为Bucholz-Ogden Ⅰ型,发生髋关节再脱位3例.股骨不截骨组26例,平均年龄(1.99±0.38)岁;术后2年内复查X线发生AVN 3例,均为Bucholz-Ogden Ⅰ型,发生髋关节再脱位1例.其他并发症有医源性骨折1例,为截骨组患儿;髋关节僵硬1例,为股骨不截骨组患儿;跛行6例,股骨截骨组3例、不截骨组3例.两组间术前AI、年龄、性别构成及脱位程度等指标差异均无统计学意义(P＞0.05).股骨截骨组开放复位术后复查AI平均(20.57±6.89)度,股骨不截骨组为(24.21±7.20)度,组间差异有统计学意义(P＜0.05);但两组术后1年及2年AI差异均无统计学意义(P＞0.05).结论 回顾性研究提示18个月～3岁DDH患儿行开放复位手术时股骨是否截骨对于术后AI的改善情况、近期AVN及髋关节再脱位率没有显著影响.因此,18个月～3岁DDH儿童行开放复位手术时推荐不常规应用股骨截骨术以减少手术创伤,但应综合术中复位难易情况考虑.     

发育性髋脱位手法复位后半脱位的成因与转归

目的　观察婴幼儿发育性髋脱位手法复位后髋关节形态学的变化。方法　对发育性髋脱位手法复位后 117例 ,共 16 1髋进行平均 7.4年的随访。临床上对髋关节功能和肌力进行了测定 ,对复位前后系列X线片进行了观察 ,正常侧作为对照组 ,X线观察的指标有 :髋臼指数、臼头指数、股骨头发育情况及髋关节间隙等。结果　全部病例髋关节的活动范围及肌力与对照组无差异。在X线上有 131个髋关节的发育与对照组的发育无差异 ,其中有 2 3髋在复位后 6个月去掉金属外展固定支架时出现了半脱位及关节间隙增大的改变 ,经平均 3年左右观察 ,逐渐恢复发育至正常。脱位侧股骨大转子骨骺出现时间比对照组延迟 1年左右。结论　发育性髋脱位手法复位后出现的半脱位及关节间隙增大不应急于手术 ,因其有逐渐发育至正常的可能。     

Developmental dysplasia of the hip: prevalence based on ultrasound diagnosis

The prevalence of sonographically normal, immature and dysplastic hips, the association between hip morphology and gender, and known risk factors for developmental dysplasia of the hip (DDH) were determined for 3613 randomly selected, healthy newborns. Hip morphology was determined according to a modified Graf's method, and stability was evaluated using a Barlow equivalent maneuver. A higher proportion of girls than boys had immature hips [16.9 % vs 9.3 %; relative risk (RR) = 2.0, 95 % confidence interval (CI) = 1.6–2.4], mi nor dysplasia (4.5 % vs 1.0 %; RR = 4.8, 95 % Cl = 2.9–8.1), and major dysplasia (1.2 % vs 0.2 %; RR = 5.5, 95 % CI =1.9–16.2). An increased risk was associated with having a sibling or parent with DDH (RR = 2.2, 95 % CI = 1.0–4.6 and RR = 3.6, 95 % CI =1.1–12.5 for girls and boys, respectively), but not with DDH in more distant relatives. Breech delivery represented a significant risk factor only for the girls (RR = 2.2, 95 % Cl =1.1–4.4). There was a strong association between hip morphology and sonographic stability (gamma = 0.98).     

高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值

目的 探讨常规静态超声在诊断临床疑似发育性髋关节异常患儿中的应用价值.方法对612名疑似发育性髋关节异常患儿的1 224个关节进行超声检查,依据 Graf法分型、Morin法评价关节的稳定性并动态追踪最终的发育结果.结果 临床疑似病例中,87.4%分类为I型形态学正常的髋关节,9.8%分类为Iia型生理不成熟型关节,8...     

Developmental dysplasia of the hip: definition, recognition, and prevention of late sequelae

When a child presents with a dislocated hip after the walking age, parents are upset, pediatricians are distraught, and lawsuits often follow. The prevention of late presentation is a goal that all practitioners should strive for. However, at this time, using current diagnostic techniques, the late presentation of DDH can be minimized but not eliminated. The AAP Subcommittee on DDH has estimated that approximately 15% of DDH at birth is not detectible, even by experienced examiners or ultrasonographers. In addition to preventing the late presentation of a developmentally dislocated hip, the prevention of premature degenerative arthritis of the hip secondary to developmental subluxation and acetabular dysplasia is equally, if not more, important in terms or morbidity and cost. It is hoped that the identification and treatment of babies with DDH at birth will have the added benefit of decreasing the incidence of degenerative arthritis of the hip in adults. As the key to early detection remains repeated, careful examination of the infant in the first year of life, it is imperative for practitioners to become as skilled as possible in performing the exam. Unfortunately, medical school curricula and pediatric and family practice residency programs often are deficient in teaching the neonatal hip examination. Strategies for clinicians to improve their examination technique include asking a pediatric orthopedic surgeon to demonstrate the examination in their nursery or attending one of the AAP courses on DDH. Starting a formal DDH screening program in the nursery is another option, using few screeners to maximize their experience. Nurse practitioners, physician's assistants, and physiotherapists could be used in addition to physicians. Having a child present with a developmentally dislocated hip after the walking age is not malpractice if the child has had repeated careful examinations. It is important to document the examinations in writing, rather than placing a check mark next to "musculoskeletal" or "hips" on standard, pre-printed exam forms. The best documentation is a handwritten note that states "the hips are stable and there is wide symmetrical abduction" at every well-child visit. At this time, careful, repeated physical exam supplemented by ultrasonography or X-rays for babies with risk factors is our best strategy to minimize the late presentation of DDH.     

Developmental dysplasia of the hip: a new approach to incidence

OBJECTIVE: The controversy over the incidence of developmental dysplasia of the hip (DDH) stems mainly from an ambiguity of criteria for defining a genuinely pathologic neonatal hip. In this study, we evaluate an algorithm we devised for the treatment of DDH, for its ability to identify those neonatal hips which, if left untreated, would develop any kind of dysplasia and, therefore, are to be included in the determination of DDH incidence. METHODS: Clinical and ultrasonographic examinations for DDH were performed on 18 060 consecutive neonatal hips at 1 to 3 days of life. Newborns with skeletal deformities, neurologic/muscular disorders, and neural tube defects were excluded. Hips that featured any type of sonographic pathology were reexamined at 2 or 6 weeks, depending on the severity of the findings. Only hips in which the initial pathology was not improved or had deteriorated were treated; all others were examined periodically until the age of 12 months. RESULTS: Sonographic screening of 18 060 hips detected 1001 instances of deviation from normal, indicating a sonographic DDH incidence of 55.1 per 1000. However, only 90 hips remained abnormal and required treatment, indicating a true DDH incidence of 5 per 1000 hips. All the others evolved into normal hips, and no additional instances of DDH were found on follow-up throughout the 12 months. CONCLUSIONS: The implementation of our protocol enables us to distinguish two categories of neonatal hip pathology: one that eventually develops into a normal hip (essentially sonographic DDH); and another that will deteriorate into a hip with some kind of dysplasia, including full dislocation (true DDH). This approach seems to allow for a better-founded definition of DDH, for an appropriate determination of its incidence, for decision-making regarding treatment, and for assessment of the cost-effectiveness of screening programs for the early detection of DDH.     

Perinatal risk factors for developmental dysplasia of the hip

AIMS—To identify perinatal risk factors for developmental dysplasia of the hip (DDH) and define the risk for each factor.METHODS—In this case control study, using logistic regression analysis, all 1127 cases of isolated DDH live born in South Australia in 1986-93 and notified to the South Australian Birth Defects Register were included; controls comprised 150 130 live births in South Australia during the same period without any notified congenital abnormalities.RESULTS—Breech presentation, oligohydramnios, female sex and primiparity were confirmed as risk factors for DDH. Significant findings were an increased risk for vaginal delivery over caesarean section for breech presentation (as well as an increased risk for emergency section over elective section), high birthweight (?4000 g), postmaturity and older maternal age; multiple births and preterm births had a reduced risk. There was no increased risk for caesarean section in the absence of breech presentation. For breech presentation, the risk of DDH was estimated to be at least 2.7% for girls and 0.8% for boys; a combination of factors increased the risk.CONCLUSIONS—It is suggested that the risk factors identified be used as indications for repeat screening at 6 weeks of age and whenever possible in infancy. Other indications are family history and associated abnormalities.     

发育性髋关节脱位手术保留和重建髋关节功能的治疗策略

目的 探讨发育性髋关节脱位保留和重建髋关节功能的治疗原则与策略.方法 收集1998年1月至2007年2月在我院治疗的有完整资料的DDH 64例(79髋),年龄11个月～12岁11个月,平均5.35岁.按T(o)nnis分度:I度22髋、Ⅱ度18髋、Ⅲ度15髋,Ⅳ度11髋.根据不同的年龄和脱位类型,采用术前充分牵引、内收肌松解等措施,有效降低髋关节周围肌肉的张力,然后择期施行I期综合手术治疗.采用Salter或Pembenon手术.术中注意保留、恢复和重建髋关节周围的动力肌(缝匠肌、阔筋膜张肌、股直肌、髂腰肌、臀肌等).术后晚负重、有规律地髋关节功能锻炼.结果 本组病例在门诊获得随访,时间23个月～9年10个月,平均6年8个月.术后疗效的评价临床采用Mckay标准,优64髋(81%),良9髋(11%),一般6髋(7.5%),优良率92%.X线片采用Severin标准,优62髋(78%),良I B9髋(11%),良Ⅱ3髋(3.8%),一般5髋(6 0A),优良率92.8%.结论 手术治疗发育性髋关节脱位时,采取术前降低髋关节的压力,术中重建髋关节功能.术后晚负重和规律性地功能锻炼等策略,有效的保留和恢复髋关节功能,明显的提高患儿的生活质量,是手术治疗发育性髋关节脱位比较理想的方法.     

Value of limited hip abduction in developmental dysplasia of the hip

BACKGROUND: Developmental dysplasia of the hip (DDH) continues to be missed by routine physical examination in up to 50% of cases. Ultrasound (US) supplementation is the best method of screening for DDH, but the resources required should not be underestimated. Limited abduction of the hip (LHA) in an infant triggers suspicion, and often an urge to treat, in most orthopaedic surgeons and pediatricians alike. This study aimed to document the value of unilateral LHA in the diagnosis and decision making of DDH, and the correlation between LHA and US. METHODS: In total, 464 infants referred from the pediatrics clinic with LHA, aged between 30 and 120 days, were included in the study. RESULTS: Physical examination revealed LHA in 186 (41%) infants, 26 of which were unilateral and 160 were bilateral. US examination showed that 13 (8.1%) patients in the bilateral LHA group and 18 (69.2) patients in the unilateral LHA group, had DDH (total number 31, 7%). CONCLUSION: Unilateral limitation of hip abduction was found to be a sensitive sign for developmental hip dysplasia, but US could be defined once again as the best golden standard before initiating treatment.     

Developmental dysplasia of the hip in South Australia in 1991: Prevalence and risk factors

To determine the prevalence of developmental dysplasia of the hip (DDH) in South Australia (SA) in 1991, the proportion of cases detected in the neonatal period and the perinatal risk factors for DDH.

Methodology:

Cases of DDH born in SA in 1991 were identified from multiple sources and their clinical data linked to perinatal data provided by midwives; five controls per case were obtained randomly from SA livebirths without congenital abnormalities and adjusted odds ratios (OR) for potential risk factors obtained by logistic regression analysis. South Australia perinatal data were also used to estimate numbers of births with perinatal risk factors for targeted screening.

Results:

Two hundred and six cases of isolated DDH were identified, giving a prevalence of 10.5 per 1000 births. Of these, 173 (84%) had been detected in the neonatal period. The perinatal risk factors for DDH were identified as breech presentation (OR 9.65), female babies (OR 4.04), first births (OR 1.91) and maternal age of 25 years or more (OR 1.53). Screening breech and firstborn female babies (23% of births) would yield approximately 51% of cases of DDH.

Conclusions:

Isolated DDH had a prevalence of 10.5 per 1000 births and 84% of cases had been detected in the neonatal period in SA. Repeated screening during infancy of 'at risk' groups of babies is recommended.     

Ultrasound hip joint screening in newborn infants. Correlation of anamnestic risk factors and hip dysplasia]

BACKGROUND: Congenital dysplasia of the hip (CDH) is the most frequent inborn deformity of the locomotor apparatus. Hereditary, pelvic respectively breech presentation or abdominal delivery, premature as well as post-term birth and twin pregnancy are considered to be anamnestic risk factors for congenital dysplasia of the hip. The results of ultrasound hip screening from July 87 until December 94 are presented with special regard to the correlation of these risk factors and the occurrence of pathologic hips. PATIENTS: 19 different orthopaedic surgeons examined the hips of 3739 newborns (female: 1837-49.1%; male: 1902-50.9%) by ultrasound (screening). 96% of the examinations were performed within a period of 5 days after birth, in a few cases the babies were up to 19 days old. METHOD: The ultrasound examinations, the assessment of the echograms and classification into types of hip were performed according to Graf's technique. Two types of ultrasonographs were used: SL-1, Siemens--5 MHz scanner; LSC 7500, Picker--7.5 MHz scanner). All investigations were assessed retrospectively over the period of time with the help of documentation forms (data of newborn baby, case history, clinical and sonographical findings, kind of therapy and procedure) and statistically checked (program SPSS 7.5, Chi-Quadrate-Test, logistic regression). RESULTS: In 239 children (6.4%) we found hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). For the entire group we achieved the following types of hips (right/left side): Ia--214 (5.7%)/224 (6.0%); Ib--2069 (55.3%)/2008 (53.7%); IIa (> or = 55 degrees)--1318 (35.3%)/1322 (35.4%); IIa (< 55 degrees)--65 (1.7%)/74 (2.0%); IIc--45 (1.2%)/71 (1.9%); D--18 (0.5%)/30 (0.8%); IIIa--8 (0.2%)/7 (0.2%); IIIb--1 (< 0.1%)/2 (0.1%); IV--1 (< 0.1%)/1 (< 0.1%). With regard to the risk factors the distribution was as follows: hereditary--302 babies (8.1%), pelvic respectively breech presentation--149 (4%), abdominal delivery--359 (6.5%), premature birth--188 (5.0%), post-term birth--164 (4.4%), twin pregnancy--73 (2%). CONCLUSIONS: In newborn babies with cases of hip dysplasia in their family (heredity) and pelvic respectively breech presentation at birth we found a significant higher rate (p < 0.05) of hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). Also, for girls and the left hip a significant higher rate was achieved. A correlation of the other mentioned risk factors abdominal delivery, premature and post-term birth as well as twin pregnancy was not evident.     

Ultrasound screening of high-risk infants. A method to increase early detection of congenital dysplasia of the hip.

Congenital dysplasia of the hip (CDH) continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real-time ultrasonography (US) is valuable in the detection of CDH in the young infant. We performed a prospective study to evaluate one US screening strategy that targets a select "high-risk newborn" population at risk for CDH aiming to increase the early diagnosis of this condition. From 1772 consecutive births at one hospital, we identified 97 (5.5%) newborns with risk factors for CDH: breech delivery, 73 babies; family history, 26 babies; postural abnormalities, five babies; and oligohydramnios, four babies. Eleven newborns had two risk factors. We studied 69 of these newborns with US. There were four cases of CDH in this group. Three of these babies had completely normal pediatric physical examination results at the time of the US study (at 14, 75, and 100 days, respectively) despite dysplasia diagnosed by US. All were successfully treated with a harness as outpatients. We conclude that a screening program entailing identification and subsequent US of the hip of newborns with specific physical and historical risk factors for CDH increases early diagnosis. Further analysis suggests this approach is cost-effective.     

Perinatal hip assessment in very low birth weight infants

Fifty healthy low birth weight infants (<1500 g) without risk factors for congenital hip dysplasia (CHD) were examined by ultrasonography (100 hips) at 40 weeks corrected age and controlled at 3 months postnatal age. Sonographic assessment was performed using the classification of Graf. A physiological delay of hip maturation was observed in 10% of the patients (type IIa). At follow-up all of them had normal hip morphology without any pathological finding. Our results suggest that prematurity alone should not be considered a risk factor for CHD.     

关节镜辅助治疗婴幼儿难复性发育性髋关节脱位短期观察

目的 探讨关节镜辅助治疗婴幼儿难复性发育性髋关节脱位(developmental dysplasia or dislocation of the hip,DDH)优缺点和短期临床效果.方法 2009年4月至2010年9月,应用关节镜辅助治疗难复性婴幼儿DDH患儿15例16髋,记录手术时间、出血量及术中阻碍髋关节复位的因素.采用改良McKay评分标准进行髋关节功能评估.应用髋臼指数(acetabular index,AI),臼头指数(acetabular head index,AHI),股骨头缺血性坏死(avascular necrosis,AVN),Severin方法分级等指标进行影像学评估.结果 手术时间平均123 min,出血平均4.8ml.妨碍髋关节复位的因素有:髋臼窝内增生的软组织、粗大的圆韧带,髋臼横韧带和内翻关节盂唇.所有患儿均获得成功复位.术后患儿均无切口感染、神经损伤等手术并发症.平均随访时间32个月(6～59个月).近期随访的6例患儿临床功能结果,优3髋,良1髋,可1髋,差1髋.近4岁以上的8髋,其中4髋(50％)为Severin分级为优良.16髋中有7髋(43.8％)出现AVN迹象,Kalamchi-MacEwenⅠ型6髋,Ⅱ型1髋.结论 关节镜辅助下治疗难复性婴幼儿DDH,手术安全创伤小,出血少,能够成功获得髋关节复位.但术后AVN可能与改良蛙式膏固定有关,关节液压力可能对股骨头血运产生影响,术后残余髋臼发育不良可能与未进行髋臼截骨有关.     

Steel骨盆三联截骨联合手术治疗大龄儿童发育性髋关节脱位疗效观察

目的 评价Steel骨盆三联截骨联合手术治疗大龄儿童发育性髋关节脱位的疗效.方法 自2006年至2012年采用Steel骨盆三联截骨术联合其他手术治疗大龄儿童发育性髋关节脱位53例(67髋),其中50例(64髋)术中行股骨近端截骨,18例(24髋)同时行股骨近端内翻截骨.手术时年龄7～16.5岁,平均10.2岁,其中男16例,女37例,双侧14例,单侧39例.按照Tonnis分级标准:Ⅰ级18髋,Ⅱ级31髋,Ⅲ级15髋,Ⅳ级3髋.所获得数据应用Spss Statistics 18.0统计软件进行统计分析.结果 所有患儿随访1.5～6.5年,平均3.3年.术前X线片显示:CEA平均-1.8°(-45°～25°),AI平均33.0°(20°～50°),AHI平均47.5％(0％～69％).最后随访X线片显示:CEA平均为38.5°(25°～50°),较术前增大40.3°;AI平均为16.8°(5°～25°),较术前减小16.2°;AHI平均为88.2％(70％～100％),较术前增大40.7％;最后随访的AI、CEA及AHI均较术前有明显改善,差异有统计学意义(P＜0.01).参照Mckay评价标准进行评定:优36髋,良23髋,可6髋,差2髋,优良率88.1％.最后随访时3髋新发股骨头缺血性坏死,根据Kalamchi and MacEwen评价标准进行评定:Ⅱ级2髋,Ⅲ级1髋.结论 Steel骨盆三联截骨联合手术治疗大龄儿童发育性髋关节脱位的疗效良好.     

Pavlik吊带早期治疗发育性髋关节脱位的疗效观察

目的 报道Pavlik吊带早期治疗发育性髋关节脱位(developmental dislocation of the hip,DDH)的临床效果.方法 2005～2007年,应用Pavilk吊带早期治疗发育性髋关节脱位78例,57例资料完整,随访超过1年.其中,男19例,女38例,单侧34例,双侧23例,总共80例异常髋关节(左侧44髋,右侧36髋),平均诊断时间66.8d(5～122d).超声波分型:Graf Ⅱa/b17髋,Ⅱc 34髋,Ⅲ及以上29髋.治疗采用Pavlik吊带,定期超声波观察及吊带调整,至超声波正常后维持4周.若Pavlik吊带3周,超声波指标未好转,改用石膏治疗.随访最少至1岁,摄片评价髋关节发育情况及股骨头骨骺变化.结果 Pavlik吊带应用最短3周,最长5个月.21例(28髋)Pavlik吊带治疗直至超声指标正常,26例(38髋)Pavlik吊带使用超过年龄8个月后,继续使用支具治疗;4例(5髋)Pavlik吊带治疗超过年龄6个月后,改换石膏治疗;6例(9髋),3周后中断Pavlik吊带治疗,改换石膏固定.Pavlik吊带治疗总有效率82.46%.无股骨头AVN发生.7例(10髋)随访时髋臼指数大于25°;3例(4髋)随访至18个月,因AI大于25°,Shenton线连贯欠佳,接受了囊外Salter骨盆截骨手术治疗,手术治疗比率为5.26%.结论 Pavlik吊带早期治疗DDH显示,初始病变严重、治疗年龄超过7周将影响预后.超声波监测是做好早期治疗工作的重要保障.