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目的总结髋臼重建手术在儿童髋关节病理性脱位中的应用及临床疗效。方法 2006年1月-2011年1月,共收治59例(59髋)儿童髋关节病理性脱位,采用髋关节切开复位联合髋臼重建手术治疗。男22例,女37例;年龄1～15岁,平均4.9岁。化脓性髋关节炎后遗病理性脱位33例,髋关节结核26例;病程1个月～10年。髋关节半脱位9例,髋关节全脱位50例。术前Harris髋关节功能评分为43～78分,平均61分。14例髋臼指数基本正常,32例轻度增大,13例明显增大。合并髋臼破坏28例;股骨头缺血性坏死25例,股骨头部分缺失12例,股骨头完全缺失6例,股骨头颈同时缺失3例;前倾角增大25例;髋内翻畸形9例。结果术后即刻摄X线片示所有髋关节均达中心性复位。55例切口Ⅰ期愈合,4例切口延期愈合。53例获随访,随访时间2～5年,平均3年。随访期间无髋关节再脱位。38例髋臼指数基本正常,15例轻度增大。前倾角15～25°,平均20°;颈干角110～140°,平均125°,头颈解剖关系基本恢复正常。术后2年髋关节活动度完全恢复正常18例,屈曲及旋转轻度受限30例,纤维强直5例;Harris髋关节功能评分为62～95分,平均87分。结论儿童髋关节病理性脱位常合并严重的髋臼及股骨头颈部骨质破坏及后遗畸形,治疗上应严格遵循个体化原则,根据患髋主要病理改变选择适当的髋臼重建术式,并结合股骨头颈重建处理,可获得满意疗效。
Objective To summarize the clinical application of acetabular reconstruction in the pathological dislocation of hip joint in children. Methods From January 2006 to January 2011, 59 cases (59 hips) of children with pathological hip joint dislocation were treated by hip arthroplasty combined with acetabular reconstruction. There were 22 males and 37 females, aged from 1 to 15 years with an average of 4.9 years old. There were 33 cases of posterior dislocation of hysterical suppurative arthritis and 26 cases of hip tuberculosis. The course of disease ranged from 1 month to 10 years. 9 cases of hip subluxation, 50 cases of total hip dislocation. Preoperative Harris hip function score of 43 to 78 points, an average of 61 points. 14 cases of acetabular index was normal, 32 cases of mild increase, 13 cases increased significantly. There were 28 cases with acetabular destruction. There were 25 cases of avascular necrosis of the femoral head, 12 cases of partial loss of femoral head, 6 cases of complete loss of femoral head, 3 cases of simultaneous deletion of head and neck of femur, 25 cases of anteversion and 9 cases of volar varus deformity . Results Immediate postoperative radiography showed that all the hip joints reached a central reset. 55 incisions healed in the first period and 4 incisions delayed healing. 53 cases were followed up for 2 to 5 years with an average of 3 years. No dislocation of the hip during follow-up. 38 cases of acetabular index was normal, mild increase in 15 cases. Anteversion 15 ~ 25 °, an average of 20 °; neck angle 110 ~ 140 °, an average of 125 °, head and neck anatomy returned to normal. In the 2 years after operation, total hip mobility was restored to normal in 18 cases, mild flexion and rotation in 30 cases, and fibrosis in 5 cases. The Harris hip function score was 62 to 95 with an average of 87 points. Conclusions Children with pathological dislocation of the hip often have severe acetabular and femoral head and neck bone destruction and posterior deformity. The treatment should follow the principle of individualism strictly. According to the main pathological changes of the hip, choose appropriate acetabular reconstruction operation, Combined with femoral head and neck reconstruction, satisfactory curative effect can be obtained.