髖臼重建手術在兒童髖關節病理性脫位的應用_《中國修復重建外科雜志》

作者：

蔣欣 , 唐學陽 , 王道喜 , 陳小亮 , 劉芳 , 謝曉麗 , 劉利君 , 彭明惺

四川大學華西醫院小兒外科（成都，610041）;

關鍵詞：

髖關節病理性脫位髖臼重建切開復位兒童

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　　目的總結髖臼重建手術在兒童髖關節病理性脫位中的應用及臨床療效。方法2006年1月－2011年1月，共收治59例（59髖）兒童髖關節病理性脫位，采用髖關節切開復位聯合髖臼重建手術治療。男22例，女37例；年齡1～15歲，平均4.9歲。化膿性髖關節炎后遺病理性脫位33例，髖關節結核26例；病程1個月～10年。髖關節半脫位9例，髖關節全脫位50例。術前Harris髖關節功能評分為43～78分，平均61分。14例髖臼指數基本正常，32例輕度增大，13例明顯增大。合并髖臼破壞28例；股骨頭缺血性壞死25例，股骨頭部分缺失12例，股骨頭完全缺失6 例，股骨頭頸同時缺失3例；前傾角增大25例；髖內翻畸形9例。結果術后即刻攝X線片示所有髖關節均達中心性復位。55例切口Ⅰ期愈合，4例切口延期愈合。53例獲隨訪，隨訪時間2～5年，平均3年。隨訪期間無髖關節再脫位。38例髖臼指數基本正常，15例輕度增大。前傾角15～25°，平均20°；頸干角110～140°，平均125°，頭頸解剖關系基本恢復正常。術后2年髖關節活動度完全恢復正常18例，屈曲及旋轉輕度受限30例，纖維強直5例；Harris髖關節功能評分為 62～95分，平均87分。結論兒童髖關節病理性脫位常合并嚴重的髖臼及股骨頭頸部骨質破壞及后遺畸形，治療上應嚴格遵循個體化原則，根據患髖主要病理改變選擇適當的髖臼重建術式，并結合股骨頭頸重建處理，可獲得滿意療效。

引用本文： 蔣欣,唐學陽,王道喜,陳小亮,劉芳,謝曉麗,劉利君,彭明惺. 髖臼重建手術在兒童髖關節病理性脫位的應用. 中國修復重建外科雜志, 2012, 26(10): 1161-1165. doi: 復制

1.	董天華. 髖關節外科學. 河南: 鄭州大學出版社, 2005: 343-363.
2.	Moon MS, Kim SS, Lee SR, et al. Tuberculosis of hip in children: A retrospective analysis. Indian J Orthop, 2012, 46(2): 191-199.
3.	劉宏, 梅海波, 劉昆. 病理性髓關節脫位誤診為先天性髓關節脫位的分析. 中國現代醫學雜志, 1998, 8(9): 39.
4.	Harris WH. Traumatic arthritis of hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
5.	Rebello G, Spencer S, Millis MB, et al. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res, 2009, 467(3): 724-731.
6.	Hadadi A, Rasoulinejad M, Khashayar P, et al. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clin Microbiol Infect, 2010, 16(8): 1270-1273.
7.	Teklali Y, El Alami ZF, El Madhi T, et al. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine, 2003, 70(4): 282-286.
8.	彭明惺, 劉利君, 張凌燕. 新生兒急性化膿性髖關節炎后遺病理性脫位的治療與預防. 中華骨科雜志, 2000, 20(10): 625-629.
9.	劉天婧, 石永言, 潘詩農, 等. Salter骨盆截骨術治療髖關節發育不良的中期隨訪. 中華外科雜志, 2010, 48(15): 1149-1153.
10.	Wu KW, Wang TM, Huang SC, et al. Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip: long-term results. J Bone Joint Surg (Am), 2010, 92(11): 2083-2094.
11.	Karlen JW, Skaggs DL, Ramachandran M, et al. The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop, 2009, 29(7): 676-682.
12.	Varner KE, Incavo SJ, Haynes RJ, et al. Surgical treatment of developmental hip dislocation in children aged 1 to 3 years: a mean 18-year, 9-month follow-up study. Orthopedics, 2010, 10: 162-166.
13.	Benum P. Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children. Acta orthopaedica, 2011, 82(1): 64-68.
14.	Ryan MG, Johnson LO, Quanbeck DS, et al. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg (Am), 1998, 80(3): 336-344.
15.	Spence G, Hocking R, Wedge JH, et al. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2009, 91(11): 2622-2636.
16.	Oga M, Arizono T, Takasita M, et al. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976), 1993, 18(13): 1890-1894.
17.	于志勇, 李金戈, 尹紅義, 等. 活動期髖、膝關節結核一期人工關節置換術的遠期療效觀察. 中國骨與關節損傷雜志, 2010, 25(6): 535-536.
18.	胡懿郃, 王賢, 李康華, 等. 化膿性髖關節炎后遺骨關節病的人工全髖關節置換治療. 中國修復重建外科雜志, 2007, 21(10): 1045-1049.
19.	Wang Q, Shen H, Jiang Y, et al. Cementless total hip arthroplasty for the treatment of advanced tuberculosis of the hip. Orthopedics, 2011, 34(2): 90.

1. 董天華. 髖關節外科學. 河南: 鄭州大學出版社, 2005: 343-363.
2. Moon MS, Kim SS, Lee SR, et al. Tuberculosis of hip in children: A retrospective analysis. Indian J Orthop, 2012, 46(2): 191-199.
3. 劉宏, 梅海波, 劉昆. 病理性髓關節脫位誤診為先天性髓關節脫位的分析. 中國現代醫學雜志, 1998, 8(9): 39.
4. Harris WH. Traumatic arthritis of hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
5. Rebello G, Spencer S, Millis MB, et al. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res, 2009, 467(3): 724-731.
6. Hadadi A, Rasoulinejad M, Khashayar P, et al. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clin Microbiol Infect, 2010, 16(8): 1270-1273.
7. Teklali Y, El Alami ZF, El Madhi T, et al. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine, 2003, 70(4): 282-286.
8. 彭明惺, 劉利君, 張凌燕. 新生兒急性化膿性髖關節炎后遺病理性脫位的治療與預防. 中華骨科雜志, 2000, 20(10): 625-629.
9. 劉天婧, 石永言, 潘詩農, 等. Salter骨盆截骨術治療髖關節發育不良的中期隨訪. 中華外科雜志, 2010, 48(15): 1149-1153.
10. Wu KW, Wang TM, Huang SC, et al. Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip: long-term results. J Bone Joint Surg (Am), 2010, 92(11): 2083-2094.
11. Karlen JW, Skaggs DL, Ramachandran M, et al. The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop, 2009, 29(7): 676-682.
12. Varner KE, Incavo SJ, Haynes RJ, et al. Surgical treatment of developmental hip dislocation in children aged 1 to 3 years: a mean 18-year, 9-month follow-up study. Orthopedics, 2010, 10: 162-166.
13. Benum P. Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children. Acta orthopaedica, 2011, 82(1): 64-68.
14. Ryan MG, Johnson LO, Quanbeck DS, et al. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg (Am), 1998, 80(3): 336-344.
15. Spence G, Hocking R, Wedge JH, et al. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2009, 91(11): 2622-2636.
16. Oga M, Arizono T, Takasita M, et al. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976), 1993, 18(13): 1890-1894.
17. 于志勇, 李金戈, 尹紅義, 等. 活動期髖、膝關節結核一期人工關節置換術的遠期療效觀察. 中國骨與關節損傷雜志, 2010, 25(6): 535-536.
18. 胡懿郃, 王賢, 李康華, 等. 化膿性髖關節炎后遺骨關節病的人工全髖關節置換治療. 中國修復重建外科雜志, 2007, 21(10): 1045-1049.
19. Wang Q, Shen H, Jiang Y, et al. Cementless total hip arthroplasty for the treatment of advanced tuberculosis of the hip. Orthopedics, 2011, 34(2): 90.

《中國修復重建外科雜志》

髖臼重建手術在兒童髖關節病理性脫位的應用

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《中國修復重建外科雜志》

髖臼重建手術在兒童髖關節病理性脫位的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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