摘要
目的 探讨单入路关节镜辅助治疗难复性小儿发育性髋关节脱位(DDH)的临床效果。 方法 2014年1月至2016年12月北京积水潭医院小儿骨科共完成12例(12髋)关节镜辅助下难复性小儿发育性髋关节脱位闭合复位术,患儿月龄10-20个月(平均14个月)。手术指征为麻醉下双侧内收肌患侧髂腰肌松解后髋关节不能中心复位的患者。采用单一内收肌下入路观察并操作,镜视下切除肥厚的圆韧带、清理髋臼底部纤维脂肪组织,盂唇内翻者行外2/3放射状切开、松解缩窄关节囊及髋臼横韧带。清理完毕后关节镜监视下手法复位,双髋人类位石膏外固定(并不进行镜下关节囊紧缩缝合),术后6-8周更换二期石膏。关节镜手术前后及更换二期石膏时均造影拍片,记录手术前后安全角、股骨头内侧化率变化情况,末次随访时均常规双髋平片观察有无股骨头缺血性坏死及测量髋臼指数。应用配对t检验对手术前后各测量指数进行统计比较。 结果 所有患儿随访18-36个月(平均26个月),全部12髋在关节镜下复位成功。安全角由术前的18.5°±3.8°增至术后的61.9°±6.5°,差异有统计学意义(t=-28.944,P<0.01)。股骨头内侧化率由术前的62%±20%增至镜下清理后的104%±16%,差异有统计学意义(t=-3.519,P<0.05)。髋臼角由术前的40.6°±5.0°降至术后的29.4°±5.0°,手术前后差异显著(t=5.463,P<0.01)。术后1例患者出现Kalamchi-MacEwen分型Ⅰ型股骨头缺血性坏死,随访2年骺板内无骨桥形成,股骨头形状修复满意。2例残留有髋臼发育不良。 结论 单入路关节镜辅助下髋臼清理闭合复位术是治疗难复性小儿发育性髋关节脱位安全有效的方法。
Objective To investigate the efficacy of single-portal arthroscopic-assisted reduction technique in the developmental dislocation of the hip in infants. Methods From January 2014 to December 2016, 12 dislocated hips in 12 children with a median age of 14 months (10 to 20 months) were treated with single-portal arthroscopic-assisted reduction technique. The indication for intervention was failure of closed reduction after bilateral adductor and unilateral iliopsoas release under anesthesia. Adductor and iliopsoas tendon were released routinely through a medial approach. Through the same medial approach a single-portal arthroscopic-assisted reduction technique was selected, with a medial sub-adductor portal for both 4.0 mm cannulated system with a 30° arthroscope and the instruments. After assessing of the intraarticular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and transverse acetabular ligament (TAL) was incised and a limited release of the capsule was performed prior to reduction of the hip. Arthrography was performed after reduction in all children. Safe zone angle and the medialization ratio on the arthrogram were compared pre and post arthroscopic reduction. Acetabular index were compared at two time points: before operation and at the latest follow-up with paired t test. Results All hips were reduced with single-portal arthroscopic procedures. The reduction was confirmed on arthrography. With a median follow-up of 26 months (18 to 36 months), all 12 hips remained stable. Safe zone angle increased from 18.5°±3.8° to 61.9°±6.5° immediately after arthroscopic reduction(t=-28.944, P<0.01);and the medialization ratio on the arthrogram increased from 62%±20% to 104%±16% immediately after arthroscopic reduction (t=-3.519, P<0.05). The mean acetabular index decreased from 40.6°±5.0° to 29.4°±5.0° at the latest follow-up (t=5.463, P<0.01). However, Kalamchi-MacEwen type Ⅰ avascular necrosis was developed only in 1 case, and residual dysplasia was observed in
作者
冯超
万世奇
吕学敏
郭源
Feng Chao;Wan Shiqi;Lü Xuemin;Guo Yuan(Department of Pediatric Orthopaedics,Belting Jishuitan Hospital,Beijing 100035,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第1期30-35,共6页
National Medical Journal of China
基金
北京市科学技术委员会首都特色项目(Z161100000516051).
关键词
髋关节脱位
小儿
关节镜检查
Dislocation of the hip
Infants
Arthroscopy
