发育性髋关节脱位手术保留和重建髋关节功能的治疗策略

摘要

Objective To retrospectively summarize the strategies to preserve and rebuild hip joint function in the surgical treatment of developmental dysplasia of the hip(DDH).Methods Between January 1998 and February 2007,79 affected hips of 64 patients underwent surgical treatment at this center were recruited in this study.These patients aged from 11 months to 12 years and 11 months old(average age,5.35 years old).According to Kalamchi criteria,5 hips were classified as type I,5 as typeⅡand 2 as typeⅢ.Before surgery,traction and adductor tenotomy was preformed to effectively reduce the tension of the muscles around the hip.Then a one-stage comprehensive operation was carried out to preserve and rebuild the functional muscles around the hip.After surgery,patients were encouraged to do regular functional exercise and late weight-bearing to facilitate rehabilitation.Results The patients were followed-up from 23 to 118 months(mean duration,6.8 years).Clinical outcomes were evaluated using the modified McKay criteria,64 hips(81%)were graded excellent,9 hips(11%)were good,and 6 hips(7.5%)were fair.Radiographic outcomes were evaluated using the Severin method,62 hips(78%)were graded excellent,9 hips(11%)were good I B,3 hips(3.8%)were good Ⅱ,and 5 hips(6%)were fair.Conclusions In the surgical treatment of developmental dysplasia of the hip,reducing the pressure of hip joint preoperatively,rebuilding hip joint function in the operation,late weight-bearing and regular exercise postoperatively can successfully preserve and rebuild hip joint function.%目的 探讨发育性髋关节脱位保留和重建髋关节功能的治疗原则与策略.方法 收集1998年1月至2007年2月在我院治疗的有完整资料的DDH 64例(79髋),年龄11个月～12岁11个月,平均5.35岁.按T(o)nnis分度:I度22髋、Ⅱ度18髋、Ⅲ度15髋,Ⅳ度11髋.根据不同的年龄和脱位类型,采用术前充分牵引、内收肌松解等措施,有效降低髋关节周围肌肉的张力,然后择期施行I期综合手术治疗.采用Salter或Pembenon手术.术中注意保留、恢复和重建髋关节周围的动力肌(缝匠肌、阔筋膜张肌、股直肌、髂腰肌、臀肌等).术后晚负重、有规律地髋关节功能锻炼.结果 本组病例在门诊获得随访,时间23个月～9年10个月,平均6年8个月.术后疗效的评价临床采用Mckay标准,优64髋(81%),良9髋(11%),一般6髋(7.5%),优良率92%.X线片采用Severin标准,优62髋(78%),良I B9髋(11%),良Ⅱ3髋(3.8%),一般5髋(6 0A),优良率92.8%.结论 手术治疗发育性髋关节脱位时,采取术前降低髋关节的压力,术中重建髋关节功能.术后晚负重和规律性地功能锻炼等策略,有效的保留和恢复髋关节功能,明显的提高患儿的生活质量,是手术治疗发育性髋关节脱位比较理想的方法.