CAJ | 학술논문

目的探讨儿童创伤性髋关节脱位的临床特点及治疗结果.方法 1990年1月至2006年12月收治的资料完整、随访超过2年的儿童创伤性髋关节脱位患者27例,男19例,女8例;年龄2.5～14.4岁,平均10.2岁.16例为高能量损伤,患者年龄(11.58±2.10)岁;11例为日常活动中受伤,患者年龄(8.30±2.93)岁.25例为后脱位,2例伤后自行复位者脱位方向不明.1例合并双侧股骨干骨折者初诊时漏诊.24例于伤后1～9h复位,其余3例复位时间超过24 h.21例闭合复位,6例切开复位.切开术中发现关节内骨软骨块3例,盂羼损伤嵌顿2例,关节囊嵌顿1例.复位后均采用单髋"人"字石膏制动4～6周.结果 27例中10岁以下者占48%.男女比例为2.4:1,左右侧别无差异.高能世损伤与低能量损伤患者年龄差异有统计学意义(t=3.392,P=0.002).全部病例随访2.4～8.3年,平均3.6年.按照Thompson和Epstein评价标准:优24例,良2例,可1例.末次随访时4例发生股骨头坏死,3例残留股骨头膨大和扁平髋.发生股骨头坏死者均为高能量损伤.延时≥24h复位组与<24h复位组股骨头坏死率的差异有统计学意义(X2=19.406,P=0.001).结论儿童创伤性髋关节脱位所需创伤能量小,合并损伤少,10岁以前多为低能量损伤.闭合复位成功率高,并发症少.闭合复位不能达到中心复位者,可行切开复位及探查修复.24h内获得中心复位、无股骨头骺缺血坏死者疗效满意.
목적 탐토인동창상성관관절탈위적림상특점급치료결과.방법 1990년1월지2006년12월수치적자료완정、수방초과2년적인동창상성관관절탈위환자27례,남19례,녀8례;년령2.5～14.4세,평균10.2세.16례위고능량손상,환자년령(11.58±2.10)세;11례위일상활동중수상,환자년령(8.30±2.93)세.25례위후탈위,2례상후자행복위자탈위방향불명.1례합병쌍측고골간골절자초진시루진.24례우상후1～9h복위,기여3례복위시간초과24 h.21례폐합복위,6례절개복위.절개술중발현관절내골연골괴3례,우찬손상감돈2례,관절낭감돈1례.복위후균채용단관"인"자석고제동4～6주.결과 27례중10세이하자점48%.남녀비례위2.4:1,좌우측별무차이.고능세손상여저능량손상환자년령차이유통계학의의(t=3.392,P=0.002).전부병례수방2.4～8.3년,평균3.6년.안조Thompson화Epstein평개표준:우24례,량2례,가1례.말차수방시4례발생고골두배사,3례잔류고골두팽대화편평관.발생고골두배사자균위고능량손상.연시≥24h복위조여<24h복위조고골두배사솔적차이유통계학의의(X2=19.406,P=0.001).결론 인동창상성관관절탈위소수창상능량소,합병손상소,10세이전다위저능량손상.폐합복위성공솔고,병발증소.폐합복위불능체도중심복위자,가행절개복위급탐사수복.24h내획득중심복위、무고골두후결혈배사자료효만의.
Objective To investigate the characteristics, therapeutic effects, and prognosis of cases with traumatic dislocations of the hip in children. Methods From January 1990 to December 2006, 27 pa-tients with traumatic hip dislocations were entered in the study, including 19 males and 8 females with an average age of 10.2 years (range, 2.5-14.4 years). Sixteen cases were caused by high-energy trauma, and 11 occurred during daily activities. 25 patients were diagnosed to have a posterior dislocation, and direction of the dislocation was not clear in 2 cases for spontaneous reduction. The diagnosis in one case was initially missed, possibly due to a combination of femur shaft fracture. The duration between injury and reduction was 1-9 h in 24 cases and over 24 h in the other 3. Twenty-one cases were treated by closed reduction, and 6 by open reduction. Of 6 cases with open reduction, 3 cases had osteoehondral fragments, 2 glenoid labrum tear and incarceration, 1 intra-articular incarceration. All the cases were immobilized with spica cast after reduc-tion for 4-6 weeks, and avoided weight-bearing for 3 months. Results The ratio of boys to girls was 2.4:1, and 48 percent of the patients aged under ten. There was significant difference between the age of high- and low-energy trauma. All patients were followed up for an average of 3.6 years (range, 2.4-8.3 years). Accord-ing to Thompson and Epstein's criterion, clinical results were excellent in 24, good in 2, fair in 1. At final follow-up four had femoral head necrosis and three developed residual coxa magna, all of them were high-en-ergy trauma. There was high risk of femoral head necrosis in the group which reduction was delayed over 24 h. Conclusion The trauma energy caused hip dislocation is lower in childhood, the combined injury was few. Closed reduction was usually easy to achieve with few complications. If central reduction was failed, open reduction should be performed. The results were satisfactory of which central reductions were obtained within 24 h and without avascular necrosis of femoral head.