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[目的]评估应用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗6~36个月婴幼儿发育性髋脱位的价值与适应证。[方法]随访1995年1月~2001年12月有完整资料的6~36个月DDH患儿193例282髋,根据开始治疗时间分为6~12个月、13~24个月和25~36个月3组,按照复位前髋臼指数和脱位程度进行分类,比较不同髋臼指数、脱位程度与治疗结果的关系。最后随访时间为5.5~11.5年,平均8年。[结果]根据1993年全国小儿髋关节会议通过的周永德发育性髋脱位疗效评价标准,本文239髋复位满意,优良率为84.8%,其中6~12个月组优良率为88.9%,13~24个月组和25~36个月优良率分别为85.3%、80.4%,3个年龄段优良结果相比无统计学差异(P>0.05);治疗前所有病例AI均大于30°,其中30°~35°组和36°~40°组的优良率分别为90.9%、87.6%,而>40°组的优良率为74.1%,前两组间优良率比较无显著性差异(P>0.05),而与>40°组比较差异则有统计学意义(P<0.05);复位前Ⅰ度、Ⅱ度、Ⅲ度脱位的远期优良率分别为86.5%、84.9%、82.5%,3组统计学检验无显著性差异(P>0.05),共10髋发生股骨头缺血性坏死,复位前脱位程度均为Ⅲ度。[结论]内收肌切断、手法闭合复位、改良蛙式石膏固定方法对6~36个月DDH患儿是一种有效的治疗方法,3岁以下开始治疗年龄对优良率的影响不大;复位前AI值小于40°优良率高;脱位程度对治疗优良率影响不大,但>2 cm的高度脱位是并发股骨头缺血性坏死的因素之一。
[Objective] To evaluate the value and indications of application of adductor muscle cut-off, manipulation and closure reduction, and improved frog plaster fixation in treatment of developmental dislocation of the hip in children aged 6 ~ 36 months. [Methods] A total of 282 hips of 193 DDH children aged 6 ~ 36 months who had complete data from January 1995 to December 2001 were divided into 6 to 12 months, 13 to 24 months and 25 ~ 36 months and 3 groups were classified according to the degree of acetabular index and dislocation before reset, and the relationship between different acetabular index, degree of dislocation and treatment outcome was compared. The final follow-up time was 5.5 to 11.5 years, an average of 8 years. [Results] According to the evaluation criteria of Zhouyong De developmental dislocation of hip which was passed by the National Pediatric Hip Conference in 1993, the satisfactory rate was 84.8% in 239 hips. The excellent and good rates were 88.9% and 13-24 in 6-12 months There was no significant difference between the three groups (85.3% vs 80.4%, P> 0.05). The AI of all the cases before treatment was greater than 30 °, of which 30 ° The excellent and good rates of ~ 35 ° group and 36 ° ~ 40 ° group were 90.9% and 87.6% respectively, while the excellent and good rates of> 40 ° group were 74.1%. There was no significant difference between the two groups (P> 0.05) , While there was a significant difference with> 40 ° group (P <0.05). The long-term excellent rates of first degree, second degree and third degree dislocation were 86.5%, 84.9% and 82.5% There was no significant difference between the two groups (P> 0.05). A total of 10 hips had ischemic necrosis of the femoral head. [Conclusion] The adductomy, manual closure and reduction, improved frog gypsum fixation is an effective treatment for children with DDH from 6 to 36 months. The age of onset below 3 years has little effect on the excellent and good rate. The pre-AI value is less than 40 °, and the excellent and good rate is high. The degree of dislocation has little effect on the excellent and good treatment rate, but the height dislocation of> 2 cm is one of the factors of avascular necrosis of the femoral head.