论文部分内容阅读
目的探讨大龄儿童髋关节发育不良(DDH)的手术治疗方法及效果。方法自2008-01—2013-12采取股骨头切开复位+股骨近端内翻缩短去旋转截骨+带缝匠肌瓣的髂骨骨块植骨增大髋臼包容、并使股骨头骨骺发育最佳的位置作为负重点治疗大龄儿童DDH 9例(10髋)。结果本组均获得随访10个月~5年。末次随访时根据Mckay标准评定临床疗效:优4例,良3例(4髋),可1例,差1例。X线片检查:髋臼指数术后下降至16°~28°,平均24°;颈干角110°~145°,平均132°;股骨颈前倾角15°~45°,平均28°。经过最长5年的随访,髋关节屈曲<90°者4髋,其中<45°1髋;无股骨头全脱位者,半脱位3髋;股骨头坏死1髋,占10%。结论根据大龄儿童DDH的特点,选择本术式可获得良好的治疗效果,显著降低股骨头坏死的发生率,推迟骨关节炎的发生,改善患儿的生存质量。
Objective To investigate the surgical treatment of elderly children with hip dysplasia (DDH) and its effects. Methods From January 2008 to December 2013, the femoral head was opened and resected, the proximal femur was revolute, the revolute osteotomy and iliac bone graft with sartorius muscle flap were used to increase the acetabular tolerance and the femoral head epiphysis The best place to develop as a negative point in the treatment of DDH in older children 9 cases (10 hips). Results The group were followed up for 10 months to 5 years. At last follow-up, the clinical efficacy was evaluated according to Mckay criteria: excellent in 4 cases, good in 3 cases (4 hips), fair in 1 case and poor in 1 case. X-ray examination: acetabular index decreased to 16 ° ~ 28 ° after surgery, an average of 24 °; neck angle 110 ° ~ 145 °, an average of 132 °; femoral neck anteversion 15 ° ~ 45 °, an average of 28 °. After a maximal 5-year follow-up, 4 hips with <90 ° hip flexion were included, of which <45 ° had 1 hips; those without full femoral dislocation had 3 hips subluxated; and 1 hip with 10% necrosis of the femoral head. Conclusion According to the characteristics of DDH in older children, this technique can be used to obtain good therapeutic effect, significantly reduce the incidence of femoral head necrosis, postpone the occurrence of osteoarthritis and improve the quality of life in children.