中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2010年
7期
523-526
,共4页
余希临%沈先涛%伍兴%徐杨
餘希臨%瀋先濤%伍興%徐楊
여희림%침선도%오흥%서양
髋脱位,先天性%矫形外科手术%治疗结果
髖脫位,先天性%矯形外科手術%治療結果
관탈위,선천성%교형외과수술%치료결과
Hip dislolation,congenital%Orthopedic procedures%Treatment outcome
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.
目的 探討髮育性髖關節脫位保留和重建髖關節功能的治療原則與策略.方法 收集1998年1月至2007年2月在我院治療的有完整資料的DDH 64例(79髖),年齡11箇月～12歲11箇月,平均5.35歲.按T(o)nnis分度:I度22髖、Ⅱ度18髖、Ⅲ度15髖,Ⅳ度11髖.根據不同的年齡和脫位類型,採用術前充分牽引、內收肌鬆解等措施,有效降低髖關節週圍肌肉的張力,然後擇期施行I期綜閤手術治療.採用Salter或Pembenon手術.術中註意保留、恢複和重建髖關節週圍的動力肌(縫匠肌、闊觔膜張肌、股直肌、髂腰肌、臀肌等).術後晚負重、有規律地髖關節功能鍛煉.結果 本組病例在門診穫得隨訪,時間23箇月～9年10箇月,平均6年8箇月.術後療效的評價臨床採用Mckay標準,優64髖(81%),良9髖(11%),一般6髖(7.5%),優良率92%.X線片採用Severin標準,優62髖(78%),良I B9髖(11%),良Ⅱ3髖(3.8%),一般5髖(6 0A),優良率92.8%.結論 手術治療髮育性髖關節脫位時,採取術前降低髖關節的壓力,術中重建髖關節功能.術後晚負重和規律性地功能鍛煉等策略,有效的保留和恢複髖關節功能,明顯的提高患兒的生活質量,是手術治療髮育性髖關節脫位比較理想的方法.
목적 탐토발육성관관절탈위보류화중건관관절공능적치료원칙여책략.방법 수집1998년1월지2007년2월재아원치료적유완정자료적DDH 64례(79관),년령11개월～12세11개월,평균5.35세.안T(o)nnis분도:I도22관、Ⅱ도18관、Ⅲ도15관,Ⅳ도11관.근거불동적년령화탈위류형,채용술전충분견인、내수기송해등조시,유효강저관관절주위기육적장력,연후택기시행I기종합수술치료.채용Salter혹Pembenon수술.술중주의보류、회복화중건관관절주위적동력기(봉장기、활근막장기、고직기、가요기、둔기등).술후만부중、유규률지관관절공능단련.결과 본조병례재문진획득수방,시간23개월～9년10개월,평균6년8개월.술후료효적평개림상채용Mckay표준,우64관(81%),량9관(11%),일반6관(7.5%),우량솔92%.X선편채용Severin표준,우62관(78%),량I B9관(11%),량Ⅱ3관(3.8%),일반5관(6 0A),우량솔92.8%.결론 수술치료발육성관관절탈위시,채취술전강저관관절적압력,술중중건관관절공능.술후만부중화규률성지공능단련등책략,유효적보류화회복관관절공능,명현적제고환인적생활질량,시수술치료발육성관관절탈위비교이상적방법.
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.
