发育性髋脱位保守治疗后股骨头坏死的分析_临床医学论文.docVIP

发育性髋脱位保守治疗后股骨头坏死的分析_临床医学论文 发育性髋脱位保守治疗后股骨头坏死的分析_临床医学论文 作者：蔡振存，张立军，吉士俊，王巍，王恩波，刘振江 【摘要】 目的 评价分析发育性髋脱位闭合复位后出现股骨头缺血性坏死的影响因素。方法 随访1995年1月至2001年12月采用内收肌切断、手法闭合复位、改良蛙式石膏固定方法治疗的有完整资料的6～36个月发育性髋脱位患者193 例282髋，并对出现股骨头缺血性坏死并发症的10 例10髋病例进行回顾性分析，比较其与复位前年龄、脱位程度、髋臼指数的关系。结果 采用Salter评分标准，6～12个月组股骨头坏死2 例，12～24个月组4 例，24～36个月组4 例。复位前髋臼指数值40°以上4 例，40°以下6 例。所有出现股骨头缺血性坏死的病例复位前髋关节都是Ⅲ度脱位。结论 内收肌切断、手法闭合复位、改良蛙式石膏固定方法对6～36个月发育性髋脱位患者是一种有效的治疗方法，能很好的降低股骨头缺血性坏死的发生率，复位前髋臼指数值的大小与股骨头缺血性坏死的发生关系不大，但大于2 cm的高度脱位是并发股骨头缺血性坏死的重要因素之一。 【关键词】 缺血性坏死;发育性髋脱位;保守治疗;婴幼儿 　　Abstract：Objective To evaluate the factors of avascular necrosis after closed reduction of developmental dislocation of hip.Methods Follow up three groups of 193 children(282 hips) with DDH suffered from adductor tenotomy，closed reduction and frog type plaster immobilization process in 1995 to 2001.To study and research 10 hips with AVN after closed reduction completely and compare the relationship between AVN and AI，dislocation degree and age.Results According to the criteria of Salter，there are 2 hips with AVN in 6～12 months group and 4 hips in 12～24 months group，4 hips in 24～36 months group.There are 4 hips appear AVN complication in more than 40°group of preoperative AI and 6 hips in bellow 40°group.The dislocation degree of all the AVN hips are Ⅲ before treatment.Conclusion Adductor tenotomy，closed reduction and frog type plaster immobilization process is a effective way to treat children with DDH between 6～36 months old.The AVN incidence rate is very low in this treat system.There was no conspicuous relation between AVN and preoperative AI but the dislocation degree with more than 2 cm is a risk factor for AVN. 　　Key words：avascular necrosis;developmental of dislocation hip;closed reduction;young children 　　发育性髋关节脱位(developmental dislocation of hip，DDH)保守治疗最常见的并发症为股骨头缺血性坏死(avascular necrosis，AVN)，如何降低其发生率一直是骨科医生所讨论的问题，使脱位的股骨头能很好的回归髋臼窝，从而刺激髋关节正常发育，同时尽可能的保证股骨头血运不受损坏是人们追求的目标。近年来，在国内外学者的共同努力下，关于保守治疗的各方面理论研究都取得了很大的进步，但对于降低AVN发生率的具体方案大家的意见尚不统一[1]。199