缝匠肌骨瓣修补大龄儿童发育性髋关节脱位髋臼缺损的疗效分析

发布时间：2018-03-13 15:22

本文选题：髋脱位　切入点：先天性　出处：《重庆医学》2017年23期 　论文类型：期刊论文

【摘要】：目的评价缝匠肌骨瓣修补髋臼缺损在治疗大龄儿童发育性髋关节脱位(DDH)的早期手术疗效。方法回顾性分析该院2014-2016年缝匠肌骨瓣修补髋臼缺损治疗17例DDH伴髋臼缺损大龄患儿(6岁)的临床资料,评价早期手术疗效。在全身麻醉下行髋关节切开复位;股骨转子下三维截骨纠正前倾角及颈干角,根据股骨头脱位高度行股骨短缩,钢板固定后重建关节囊。取髂骨缝匠肌骨瓣翻转至髋臼上缘修补髋臼缺损。手术后双下肢贝氏石膏固定6~8周。逐渐行髋关节功能训练,髋关节功能参照Mckay′s标准进行评估,髋关节形态评估参照Severin′s X射线标准进行。结果 17例患儿均获得随访,随访时间6~29个月。术后股骨头复位良好,头臼包容满意;未出现伤口感染及股骨头坏死。术后随访结果,Mckay′s标准:优2例(2髋),良13例(15髋),可2例(2髋),优良率为88.2%,Severin′s标准:优11例,良49例。结论大龄儿童(6岁)DDH采用髂骨缝匠肌骨瓣修补髋臼缺损,术后骨性愈合好,能有效改善髋关节的髋臼对股骨头的包容,术后关节功能良好。
[Abstract]:Objective to evaluate the early operative effect of repairing acetabular defect with sartorius muscle bone flap in elderly children with developmental dislocation of hip. Methods 17 cases of DDH with acetabular defect were retrospectively analyzed. The clinical data of the older children (6 years old), To evaluate the effect of early operation. Open reduction of hip joint under general anesthesia, correction of anteversion angle and neck shaft angle by subtrochanteric osteotomy, short contraction of femur according to the height of dislocation of femoral head. The bone flap of iliac sartorius muscle was reversed to the upper edge of acetabular to repair the acetabular defect. After the operation, the lower extremities were fixed with Bayesian plaster for 6 to 8 weeks. The function of hip joint was gradually trained, and the function of hip joint was evaluated according to Mckay's standard. Results all the 17 cases were followed up for 6 ~ 29 months. The femoral head was restored well and the head and acetabulum was well contained after operation. There was no wound infection or femoral head necrosis. The results of follow up were as follows: excellent 2 cases, good 13 cases 15 hips, fair 2 cases, and excellent and good rate 88. 2% Severinus standard: 11 cases were excellent. Conclusion the bone flap of iliac sartorius muscle was used to repair the acetabular defect in the older children aged 6 years, and the bone healed well after operation, which can effectively improve the acetabular inclusion of the femoral head and the function of the joint after operation.
【作者单位】：重庆医科大学附属儿童医院骨科中心;
【基金】：国家临床重点专科建设项目资助(国卫办医函【2013】544)
【分类号】：R726.8

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