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。

Causes of subluxation after closed reduction in developmental dislocation of hip

Objective To observe the morphologic change and function after closed reduction in developmental dislocation of the hip (DDH) in children. Methods A follow up on an average of 7.4 years after closed reduction was carried out in 117 cases of DDH (161 hips; unilateral 73, bilateral 44) under 3 years of age. The hip joints were examined by the clinical features and a retrospective study of series X ray images, including acetabular index, acetabular head index and the development of the femoral head. Results The movement was normal in all reducted hips, 131 hips showed normal development on X ray film, 23 hips had a subluxation and widened joint space and gradually recovered near normal 3 years later. The appearance of epiphysis of greater trochanter was prolonged about one year in the dislocated hip. Conclusion An early operation is unnecessary to subluxation or a widened joint space after closed reduction of DDH which may be developed step by step into normal.