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例因术中骨盆截骨旋转角度过大,髋臼后方包容欠佳,术后髋臼软骨发育不良,再次行骨盆Pemberton截骨关节囊紧缩修复矫正;2例因术前合并多关节松弛症,关节稳定性相对较差,术后并发Perthes病行髋臼周围截骨手术矫正治疗。结论儿童发育性髋关节脱位术后渐发脱位与患者自身合并疾病、髋关节病变程度、手术操作等因素均有密切关系,准确的术前评估、适合的手术方式、精确的手术操作、术后早期干预治疗是防治术后渐发脱位的有效方法。

The causes analysis of progressive dislocation after pelvic Salter osteotomy for treatment of developmental dislocation of the hip

Objective To investigate the causes of progressive dislocation after pelvic Salter osteotomy in the treatment of developmental dislocation of the hip(DDH).Methods Pelvic Salter osteotomy was used to treat 63 children with DDH,of whom 7 cases had progressive dislocation,the incidence causes was analyzed.Results All patients were followed up for 12~89 months.The 3 of the 7 cases with progressive dislocation were due to postoperative joint capsule loosing,which could not effectively maintain joint stability,the hip was restored stability by wearing hip outreach teams;2 cases were due to the pelvic osteotomy rotation angle that was too large during surgery,the tolerance of posterior acetabulum was not good,acetabular cartilage development was not good after surgery,who were adopted with pelvic Pemberton osteotomy joint capsule tightening repair correction again;2 cases were due to preoperative combination of multi-joint relaxation,joint stability was relatively poor,combined with Perthes disease after surgery,and who were performed with osteotomy surgery correction treatment around the acetabulum.Conclusions The postoperative progressive dislocation of DDH in children is closely related to the patient′s own disease factors,the degree of hip lesion,and the surgical operation and so on.Accurate preoperative evaluation,appropriate surgical method,accurate surgical operation and early postoperative intervention are effective methods to prevent and treat the postoperative progressive dislocation.