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患儿男,出生136d。因臀位难产分娩时助产士用力不当,致使左髋关节脱位,当时未引起注意,136d后才至门诊复查。查体:发育正常,左髋关节外展受限,左下肢短缩约1cm,左股骨大粗隆较健侧明显上移,艾利氏征阳性,望远镜征阳性。X线片示:左侧Shenton线不连续,左侧股骨头在Perkin方格外上方,左侧髋臼、股骨头发育与健侧相同。结合产伤病史,可确诊为陈旧性髋关节脱位。整复方法:在氯胺酮麻醉下,先牵引左下肢,同时不断摇晃患肢,角度从小到大,并按摩患髋,使粘连松解,后采用整复小儿先天性髋关节脱位手法复位,成功后用蛙形石膏外固定,术后摄片检查示左股骨头对位良好。1个月后去除石膏进行功能锻炼,并每周复查X线片,连续3次,无再脱位。至今随访6年,患髋发育良好,行走正常。
Children male, born 136d. Midwifed labor due to breech delivery improper midwifery, resulting in dislocation of the left hip, did not pay attention, 136d before going to the clinic for review. Physical examination: normal development, limited left hip abduction, left lower extremity shortened about 1cm, left femur greater trochanter than the contralateral side was significantly shifted, Elliott sign positive, binoculars positive sign. X-ray showed: the left Shenton line is not continuous, the left femoral head above the top of the perforation, the left acetabulum, femoral head development and contralateral same. Combined with the history of birth injuries, can be diagnosed as obsolete hip dislocation. Rehabilitation method: under ketamine anesthesia, the first lower left leg traction, while constantly shaking the limbs, angle from small to large, and massage the affected hip, the adhesions release, the use of reconstructive surgery in children with congenital dislocation of hip dislocation after successful External fixation with frog plaster, postoperative radiography showed left femoral head alignment well. 1 month after removal of plaster for functional exercise, and weekly review of X-ray film, 3 times in a row, no dislocation. Up to now 6 years follow-up, hip dysplasia, normal walking.