论文部分内容阅读
[目的]探讨应用一期Salter截骨联合股骨近端截骨在3～8岁延迟治疗发育性髋关节脱位(LDH)的临床疗效及优势。[方法]回顾性分析本院2006年6月～2008年4月对3～8岁之前未经治疗的34例(39髋)发育性髋关节脱位患儿采用无术前牵引的一期联合手术治疗的临床资料。共34例(39髋),男5例,女29例;右髋16例,左髋17例,双髋3例;按照Tonn is分级,Ⅱ级4髋,Ⅲ级16髋,Ⅳ级19髋,术前髋臼指数平均33°(28°～42°);手术年龄平均4.5岁(3～8岁)。[结果]术后病人全部获得随访,平均随访3.5年(2.5～4年3个月),术后改善髋臼指数平均15.5°(10°～20°),1髋(2.5%)半脱位,1髋(2.5%)发生股骨头坏死征。按照Mckay临床评定标准,其中优11髋(28%),良23髋(59%),可3髋(8%),差1例(3%),优良率89%。Severin X线评定标准:优13髋(33%),良23髋(59%),可2髋(5%),差1例(3%),优良率92%。[结论]一期联合手术无需术前牵引,能同时纠正髋关节软组织和骨性病理改变。减少术后并发症发生率,增加关节功能优良率。减少患儿痛苦及住院时间。效果优良,值得在适合的病例中推广。
[Objective] To explore the clinical efficacy and advantage of using Salter osteotomy combined with proximal femoral osteotomy for delayed treatment of developmental dislocation of the hip (LDH) at 3 ~ 8 years old. [Methods] A retrospective analysis of our hospital from June 2006 to April 2008 on the 3 to 8 years old untreated 34 cases (39 hips) of children with developmental dislocation of the hip without a preoperative traction of a joint operation Treatment of clinical data. A total of 34 patients (39 hips), 5 males and 29 females; right hip in 16 cases, left hip in 17 cases, double hip in 3 cases; according to Tonn is grading, Ⅱ grade 4 hips, Ⅲ grade 16 hips, Ⅳ grade 19 hips , Preoperative acetabular index average 33 ° (28 ° ~ 42 °); the average age of surgery 4.5 years (3 to 8 years old). [Results] All the patients were followed up for 3.5 years (2.5-3 years) with average follow-up of 15.5 ° (10 ° ~ 20 °) and 1-hips (2.5%) after operation. 1 hip (2.5%) osteonecrosis of the femoral head syndrome. According to Mckay’s clinical evaluation criteria, 11 were excellent (28%), 23 were good (59%), 3 were fair (8%) and 1 was poor (3%). The Severin X criteria were excellent in 13 hips (33%), good in 23 hips (59%), fair in 2 hips (5%) and poor in 1 (3%). [Conclusion] The one-stage combined surgery without preoperative traction can simultaneously correct the soft tissue and hip joint pathological changes. Reduce the incidence of postoperative complications, increase the rate of excellent joint function. Reduce children’s pain and hospitalization time. Effective, worth promoting in appropriate cases.