CAJ | 학술논문

目的探讨关节镜辅助治疗难复性小儿发育性髋关节脱位(DDH)的适应证、手术方法及临床效果. 方法 2005年5月至2006年12月,共完成17例(23髋)关节镜下髋臼清理、盂唇成型、镜下复位术,其中男2例,女15例,年龄4～48个月(平均19.1个月),右侧14髋,左侧9髋,其中单髋11例,双髋6例.均为麻醉前、后闭合手法复位失败患者.采用髋关节前侧和大粗隆前方入路相结合,镜视下切除拉长、磨损的圆韧带、清理髋臼底部纤维脂肪组织、切除髋臼横韧带,除第1例采用盂唇内缘放射状切开外,其余均采用盂唇外2/3切开,关节镜监视下手法复位,必要时切断内收肌肌腱,髋屈曲外展稳定位置石膏外固定.结果全部23髋在关节镜下复位成功,随访12～31个月(平均25个月),除1例术前即有股骨头坏死外,全组患者无股骨头无菌性坏死发生.按全国先天性髋脱位疗效评定标准,优14髋,良1髋,可2髋,差6髋.分别测量成功组与失败组术前的前倾角、髋臼角、CE角及Zionts分级,进行统计学分析比较,两组术前前倾角、髋臼角的差异具有统计学意义,CE角及Zionts分级差异无统计学意义.结论在掌握好适应证的前提下,关节镜下髋臼清理、盂唇成型是辅助治疗小儿DDH的有效方法,与传统开放手术相比具有创伤小、恢复快的优点.前倾角小于40°、髋臼角小于35°是关节镜手术的适应证.术前的CE角及Zionts分级,对选择关节镜手术的适应证意义不大.盂唇外2/3的切开方式,有利于保持盂唇内缘的完整性,防治术后再脱位的发生.
목적 탐토관절경보조치료난복성소인발육성관관절탈위(DDH)적괄응증、수술방법급림상효과. 방법 2005년5월지2006년12월,공완성17례(23관)관절경하관구청리、우진성형、경하복위술,기중남2례,녀15례,년령4～48개월(평균19.1개월),우측14관,좌측9관,기중단관11례,쌍관6례.균위마취전、후폐합수법복위실패환자.채용관관절전측화대조륭전방입로상결합,경시하절제랍장、마손적원인대、청리관구저부섬유지방조직、절제관구횡인대,제제1례채용우진내연방사상절개외,기여균채용우진외2/3절개,관절경감시하수법복위,필요시절단내수기기건,관굴곡외전은정위치석고외고정.결과 전부23관재관절경하복위성공,수방12～31개월(평균25개월),제1례술전즉유고골두배사외,전조환자무고골두무균성배사발생.안전국선천성관탈위료효평정표준,우14관,량1관,가2관,차6관.분별측량성공조여실패조술전적전경각、관구각、CE각급Zionts분급,진행통계학분석비교,량조술전전경각、관구각적차이구유통계학의의,CE각급Zionts분급차이무통계학의의.결론 재장악호괄응증적전제하,관절경하관구청리、우진성형시보조치료소인DDH적유효방법,여전통개방수술상비구유창상소、회복쾌적우점.전경각소우40°、관구각소우35°시관절경수술적괄응증.술전적CE각급Zionts분급,대선택관절경수술적괄응증의의불대.우진외2/3적절개방식,유리우보지우진내연적완정성,방치술후재탈위적발생.
Objective To explore the indication, operative technique and clinic effect of arthroscopy in the treatment of children developmental dysplysia of the hip (DDH) who had failed to be reduced by manipulative close reduction.Methods 17 cases (24 hips) of DDH were treated with debridement of the acetabulum and acetabular labrum plasty under the arthroscope.2 cases were male, 15 were female, and the age varied from 4 to 48 months (average 19.1 months).14 right and 9 left hips were involved.11 cases were single hip dislocation and 6 were bilateral dislocation.Manipulative reduction under general anesthesia were tried and failed in all cases.Anterior and anterosuperior great trochanter portals were used to excise the hypertrophic, elongated and abrased ligamentum tere, fibrosis and fat tissues on the acetabular bottom were removed, the transverse ligament of acetabulum was resected also.At last the posterior outer two-thirds ram of labrum was incised except in the first case in whom the inner two-thirds ram was incised.Manipulative reduction and plaster cast immobilization within safe and stable position were done.Adductor tendon was released if necessary.Results Reduction was achieved successfully in all 23 hips and no avascular necrosis of the femoral head (ANF) occurred in duration of 12 to 31 months (average of 25 months) postoperative follow-up except one who had suffered from ANF before the surgery.According to the national clinical outcome score scale of developmental dysplysia of the hip in children, excellent result was in 14 cases, good in 1, fair in 2 and poor in 6.Statistical analysis for the effective factors between successful group and failure group was carried out with anteversion, angulus acetabularis, center-edge angle and Zionts grade.The anteversion and angulus acctabularis had significant difference between two groups before surgery, but there were no statistical difference of the center-edge angle and Zionts grade between two groups.Conclusions Arthroscopically-assisted acetabular debridement and labrum plasty procedures are effective methods to help reduction in developmental dysplasia of the hip in children if appropriate indications are selected.Compared with the other open procedure, it has advantages of minimal invasion and faster wound healing.Base on our primary observation, less than 40 degree acetabular anteversion and less than 35 degree angulus acctabularis are implied to be good indications for arthroscopic surgery.Center-edge angle and Zionts grade before the surgery seems to be no affect on the surgical choice.Posterior two-thirds of outer-ram incision of the acetabular labrum is benefit for keeping the rest inner-ram integrity of the labrum which may prevent the femoral head redislocation from acetabulum.