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[目的]探讨不同年龄组大龄发育性髋关节脱位(developmental dysplasia of the hip,DDH)患儿的手术治疗效果。[方法]2006年11月~2014年6月采用髋关节切开复位,骨盆Pemberton、Dega髋臼成形或三联截骨,股骨旋转短缩截骨结合内收肌切断等手术一期治疗大龄儿童DDH 91例(104髋),按年龄情况将患儿分为两组:低龄组(<10岁):61例(70髋),年龄6~9.8岁,平均7.9岁。高龄组(≥10岁):30例(34髋),年龄10~15岁,平均12.5岁。[结果]91例术后均获得随访,随访时间2~8年,根据Severin影像学评价标准,低龄组:Pemberton术后优良率91.43%,Dega术后优良率85.71%,骨盆三联截骨术后优良率85.71%;高龄组:Pemberton术后优良率58.33%,Dega术后优良率50.00%,骨盆三联截骨术后优良率40.00%。根据Mckay临床评价标准,低龄组:Pemberton术后优良率88.57%,Dega术后优良率85.71%,骨盆三联截骨术后优良率85.71%;高龄组:Pemberton术后优良率58.33%,Dega术后优良率41.67%,骨盆三联截骨术后优良率40.00%。[结论]本研究针对6岁以上大龄DDH患儿的手术疗效进行随访,发现大龄DDH是可以选择性的通过手术治疗的,同时通过比较两组患儿手术疗效的差异,发现低龄组的术后临床及影像学优良率均高于高龄组,提示DDH患儿需要早期手术改善头臼覆盖关系,才有可能获得较好的临床效果。
[Objective] To investigate the surgical treatment of children with developmental dysplasia of the hip (DDH) in different age groups. [Methods] From November 2006 to June 2014, the patients underwent open reduction, open reduction of the hip, pelvis Pemberton, Dega acetabulum or triple osteotomy, femoral rotation shortening osteotomy, Ninety-one patients (104 hips) were divided into two groups according to their age: young group (<10 years old): 61 cases (70 hips), ranging in age from 6 to 9.8 years with an average of 7.9 years old. Elderly group (≥10 years): 30 cases (34 hips), aged 10 to 15 years, mean 12.5 years. [Results] 91 cases were followed up for 2 to 8 years. According to Severin imaging evaluation criteria, the excellent and good rates of postoperative Pemberton were 91.43% and 85.71% after Dega, respectively The excellent and good rate was 85.71%. In the advanced age group, the excellent and good rate of Pemberton was 58.33%, the excellent and good rate was 50.00% after Dega, and the excellent and good rate was 40.00% after pelvic triple osteotomy. According to Mckay’s clinical evaluation criteria, the excellent and good rate of postoperative Pemberton was 88.57%, the excellent and good rate of Dega was 85.71%, the excellent and good rate of postoperation pelvic triple osteotomy was 85.71% Excellent rate of 41.67%, pelvic triple osteotomy excellent rate of 40.00%. [Conclusion] This study was aimed at the follow-up of children with DDH at the age of 6 and above. We found that DDH in older children can be selectively treated by surgery. By comparing the difference in the curative effect between the two groups, we found that postoperative Clinical and imaging excellent rate are higher than the elderly group, suggesting that children with DDH need early surgery to improve the coverage of the acetabular cover, it is possible to obtain better clinical results.