Chiari骨盆内移截骨并加盖术治疗大龄儿童发育性髋关节脱位术后并发症分析

目的：对Chiari骨盆内移截骨并加盖术，部分合并股骨近端旋转截骨治疗大龄儿童发育性髋关节脱位术后出现的并发症进行分析，并对其产生的原因进行分析，以期能找出降低术后并发症的方法和措施。方法：本组患儿42例，男t0例，女32例，年龄6岁～16岁，平均9．2岁。采用髋关节前方切口，切开关节囊，找见真臼，清理真臼内软组织，复位股骨头于真臼内；真髋臼缘上方0．5cm处行骨盆完全截骨，髂骨块植入截骨处，行加盖，进一步增加股骨头的包容。部分患儿行股骨近端旋转截骨，纠正前倾角。结果：42例患儿经1～6年的随访（平均3．5年），出现再脱位3例，股骨头缺血性坏死2例，坐骨神经损伤1例，髋关节功能障碍4例。结论：Chiari骨盆内移截骨并加盖术虽然是治疗大龄儿童发育性髋关节脱位的一种较为有效的方法，但术后并发症的发生率较高。提示我们在术前一定要选择合适的病例，术中仔细操作，尽量避免并发症的发生。

Analysis of Postoperative Complications of DDH in Older Children Treated By Chiari Pelvic Os- teotomy And Shelf Operation

Objective： To evaluate the clinical effect of Chiari pelvic osteotomy and shelf operation for treatment of developmental dislocation of the hip （DDH） in elder children, and to analyze its postop complications. Methods： There were 42 cases, including 10 male and 32 female, aging from 6 to 16 years old （mean 9.2 years old）, were underwent the following procedures： open articular capsule, find the true acetabulum and clean up it, reduce femoral head into the true acetabulum, truncate the ilium completely 0.5 centimeter above the edge of true acetabulum, inlay bone block to acetabulum superior border in order to enlarge the containment of femur head. And proximal femoral osteotomy was carried out on partial patients in order to redress the anteversion angle. Results： All the cases were followed up for average 3.5 years （from 1 year to 6 years）, redislocation was noted in 3 cases, ＂femur head necrosis in 2 eases, injury of sciatic nerve in 1 case and hip joint functional disturbance in 4 cases after operation. Conclusion： Though Chiari pelvic osteotomy and shelf operation is an effective method to treat developmental dislocation of the hip in elder children, the incidence rate of postoperative complications is high. It hints us that we should choose the suitable case before operation and manipulate carefully during the operation in order to avoid the complications.