CAJ | 학술논문

目的探讨髋关节牵伸器在重度髋关节发育不良关节成形术中的应用价值.方法 2006年4月至2008年10月对6例(9髋)CroweⅣ型髋关节发育不良及1例(2髋)髋内翻继发髋关节发育不良患者行关节成形术,男2例,女5例;年龄12～5岁,平均30岁.术前用自行研制的髋关节牵伸器牵伸髋关节,首次牵开1.0～2.0 cm,次日开始以1 mm/d速度缓慢牵伸,直至股骨头降至真臼旋转中心水平.更换为皮牵引,重量3kg,牵引针眼愈合后行关节置换术6例(10髋)、臼盖成形术1例(1髋).结果 6例(9髋)的股骨头或大转子顶端牵伸至真臼旋转中心水平.牵伸距离4.0～5.5 cm,平均4.45 cm;牵伸时间30～60 d,平均43 d.无坐骨神经损伤及针眼严重感染发生.关节成形术中未行软组织松解及股骨短缩截骨.1例(2髋)在一侧髋关节牵伸至6.0 cm时加快牵伸速度为1.25 mm/d,12 h后出现腓深神经不全损伤.行分期全髋关节置换,术中股骨短缩截骨3 cm,腓深神经不全损伤半年后恢复.全部患者随访1.5～3.0年,平均2.5年.均获得双下肢等长,臀中肌肌力增加1～2级.Harris髋关节评分由术前平均56.2分提高至术后1年92.2分.结论髋关节牵伸器可将股骨头牵伸至真臼旋转中心水平,行关节成形术时无须软组织松解及股骨短缩截骨,可减少创伤,缩短手术时间,改善外展肌功能.应严格按照1mm/d速度牵伸,以免引起神经损伤.
목적 탐토관관절견신기재중도관관절발육불량관절성형술중적응용개치.방법 2006년4월지2008년10월대6례(9관)CroweⅣ형관관절발육불량급1례(2관)관내번계발관관절발육불량환자행관절성형술,남2례,녀5례;년령12～5세,평균30세.술전용자행연제적관관절견신기견신관관절,수차견개1.0～2.0 cm,차일개시이1 mm/d속도완만견신,직지고골두강지진구선전중심수평.경환위피견인,중량3kg,견인침안유합후행관절치환술6례(10관)、구개성형술1례(1관).결과 6례(9관)적고골두혹대전자정단견신지진구선전중심수평.견신거리4.0～5.5 cm,평균4.45 cm;견신시간30～60 d,평균43 d.무좌골신경손상급침안엄중감염발생.관절성형술중미행연조직송해급고골단축절골.1례(2관)재일측관관절견신지6.0 cm시가쾌견신속도위1.25 mm/d,12 h후출현비심신경불전손상.행분기전관관절치환,술중고골단축절골3 cm,비심신경불전손상반년후회복.전부환자수방1.5～3.0년,평균2.5년.균획득쌍하지등장,둔중기기력증가1～2급.Harris관관절평분유술전평균56.2분제고지술후1년92.2분.결론 관관절견신기가장고골두견신지진구선전중심수평,행관절성형술시무수연조직송해급고골단축절골,가감소창상,축단수술시간,개선외전기공능.응엄격안조1mm/d속도견신,이면인기신경손상.
Objective To evaluate the application value of hip joint traction device in treating serious developmental dysplasia of the hip. Methods From April 2006 to October 2008, 6 cases Crowe Ⅳ hip dysplasia and 1 case dysplasia of acetabulum in coxa vara underwent arthroplasty. There were 2 males and 5 females with an average age of 30 years (range, 12-45). All patients were admitted to the hospital for the distraction, which was 1.0-2.0 cm on the first day and 1 mm/d thereafter, until slowly pulling femur head to the real acetabulum. Changing to the skin distraction with 3 kg, arthroplasty was performed after pin sites healing. Results Seven femur heads of 5 cases and two greater trochanters of 1 case were pulled into the real acetabulum, average distraction length was 4.45 cm, and average time was 43 d, no nerve injury and infection of pin sites. Soft tissue release and femur shortening were not required in arthroplasty. One case accelerated pulling speed to 1.25 mm/d when left femur head was distracted to 6.0 cm, so that the partial left deep peroneal nerve injury happened after 12 h. Ending distraction, bilateral THA was undergone by stages and femur shortening 3 cm in operation, nerve injury restored after half year. All patients were followed up for average 2.5 years (range, 1.5-3.0). In all patients, two limb lengths were equal, middle gluteal muscle myodynamia improved about 1-2 grades. The mean Harris hip score improved from 56.2 to 92.2 one year after operation. Conclusion The hip joint traction device could pulled femoral head to the real acetabulum rotating center, as a result, femur shortening and soft tissue release were not required while performing arthroplasty, and through which wound and operative time were decreased, middle gluteal muscle function was improved. However, we should strictly pulled the femur head at 1 mm/d to avoid nerve injury.