Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位

目的　应用Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位 ,从而降低术后髋关节脱位、僵硬和股骨头坏死发生率。方法　自 1989年 8月 - 1999年 8月 ,用Pemberton手术为主多种辅助手段治疗大龄儿童 (7～ 14岁 )先天性髋脱位 4 6例 (5 8髋 ) ,随访 2～ 9年 ,平均 5年 3个月。辅助手段包括 :①髂腰肌及内收肌切断 ,股骨髁上骨牵引 ;②股骨粗隆下旋转加短缩截骨 ;③单髋人字石膏制动 ;④髋关节早活动 ,晚负重 ;⑤术后被动活动髋关节加主动功能锻炼。结果　髋关节完全复位率10 0 % ,髋关节屈曲小于 90°者 4髋 ,占 6 9% ,按Salter提出的股骨头坏死诊断标准 4 6例 (5 8髋 )中 ,股骨头坏死 6髋 ,占 10 3% ,明显降低了大龄儿童先天性髋脱位术后髋关节僵硬、股骨头坏死率。结论　Pemberton手术为主多种辅助手段治疗大龄儿童先天性髋脱位疗效确切 ,优良率高。

Treatment of the congenital hip dislocation of the high age children by pemberton operation and accessory methods

Objective Pemberton operation and accessory methods were used for the treatment of congenital hip dislocation in high age children to reduce the rate of redislocation,hip stiffness and avascular necrosis of the femoral head after operation.Methods Between August 1989 and August 1999,58 hips with congenital dislocation in 46 cases of high age children (7 years old to 14 years old) were treated by Pemberton operation and accessory methods,and were followed-up from 2 years to 9 years(average,5 years and 3 months).The accessory methods include:1)cutting of iliopsoas and adductor muscles and traction of the femur.2) femoral shortening and derotational osteotomy.3) plaster fixation of hip.4) early movement of the hip joint after operation and late ambulation.5) rehabilitation of the hip joint passively and actively.Results The complete reduction rate of the hip was 100%.Four cases(6.9%) can only flex their hip joint below 90 degrees.According to the Salter standard of avascular necrosis of the femoral head,the necrosis occurred in 6 cases(10.3%).The rate of avascular necrosis of femoral head and hip stiffness in high age children after the treatment were reduced obviously.Conclusion Pemberton operation and accessory methods were preferred in treating the congenital hip dislocation in high age children.