前方小切口单纯切开复位治疗婴幼儿发育性髋关节脱位的短期疗效分析

目的分析前方小切口单纯切开复位治疗婴幼儿发育性髋关节脱位(developmental dislocation of the hip,DDH)的短期疗效。方法收集分析2013年1月至2017年12月于我院闭合复位失败后行前方小切口单纯切开复位石膏固定术的23例DDH患儿资料。其中男5例,女18例,平均年龄为13.22(4~22)个月。右髋9例,左髋12例,双髋2例。术前按国际髋关节发育不良协会(International hip dysplasia institute,IHDI)标准分度,I度0例,II度1例,III度11例,IV度13例。平均随访时间30(13~50)个月。根据IHDI标准对患儿的髋脱位程度进行判断,分析术前牵引时间、手术时间、术中出血量、住院时间、术中使用造影剂量等数据。分别观察并测量手术前后及末次随访的股骨头高度、宽度、骨骺指数及软骨性髋臼指数(cartilage acetabular index,CAI)。在末次随访的X线片上测量髋臼指数(acetabular index,AI)、股骨头骺线中心-髋臼边缘角(O-Edege Angle,OEA)。应用Salter标准判断有无股骨头坏死(avascular necrosis,AVN)。结果术前平均牵引6(2~9)天,平均手术时间为111.21(69~178)min,术中平均出血量为7.4(5~20)ml,术后人字位石膏平均屈曲98°(90°~100°),外展51°(45°~60°)。平均住院时间为14.4(7~23)天。术前平均髋臼指数为(37.64±4.33)°,末次随访时为(26.88±4.44)°,两者相比差异有统计学意义(P=0.00)。术前平均OE角为(-44.32±20.93)°,至末次随访时为(12.80±5.52)°,两者相比差异有统计学意义(P=0.00)。骨骺指数在术后2年内呈小幅度上升,但患侧股骨头的骨骺指数则呈现出先减小后增大的趋势,总体上均小于健侧。根据Salter标准,3髋(12%)出现AVN征象,所有病例均未出现再脱位情况。结论年龄≤2岁的DDH患儿闭合复位失败后,经前方小切口单纯切开复位的短期疗效良好。

Anterior mini-open reduction in the treatment of infantile developmental dislocation of the hip

Objective To explore short-term outcomes of a anterior approach with a novel mini-Bikini incision in the treatment of DDH(developmental dysplasia of the hip)patients within 2 years of age.Methods This study retrospectively analyzed 23 patients with DDH who were treated with open reduction through the anterior miniincision in Shengjing Hospital from January 2013 to December 2017.Five boys and 18 girls with an average age of 13.22 months(range:4-22 months)were included.The left hip was affected in 12 cases,right in 9 cases,and both in 2 cases.According to the International Hip Dysplasia Institute(IHDI)criteria,the clinical types were I(0 hip),II(1 hip),III(11 hips)and IV(13 hips).The average follow-up was 30 months(range:13-50 months).Preoperative traction time,operation time,intraoperative blood loss,hospital stay,and the dose of intraoperative contrast agent were collected.The height and width of the femoral head,femoral head epiphyseal index(height/width×100)and cartilage acetabular index(CAI)were measured and calculated preoperatively,postoperatively and at the final follow-up.Acetabular Index(AI)and O-Edege Angle(OEA)were measured on the latest X-ray.The Salter criteria was used to assess avascular necrosis(AVN)of the femoral head.Results The mean preoperative traction lasted 6 days(range:2-9 days).The mean operating time was 111.21 min(range:69-178 min).The mean blood loss was 7.4 ml(range:5-20 ml).The average plaster flexion was 98°(90°-100°)and the abduction was 51°(45°-60°).The average hospital stay was 14.4 days(range:7-23 days).The average AI decreased from(37.64±4.33)°before reduction to(26.88±4.44)°at the final follow-up(P=0.00).The preoperative average OE Angle increased from(-44.32±20.93)°before surgery to(12.80±5.52)°at the final follow-up(P=0.00).The epiphyseal index of the femoral head generally showed a slight increase within 2 years after surgery.However,it decreased at first and increased later on the affected side,maintaining smaller than that on the healthy side.Three hips(12%)showed signs of AVN,while no cases needed further osteotomy.Conclusions An anterior approach with mini-Bikini incision would yield satisfactory short-term outcomes for children less than 2 years after failed close reduction.