小儿发育性髋关节脱位的关节镜下治疗_临床医学论文.docVIP

小儿发育性髋关节脱位的关节镜下治疗_临床医学论文 小儿发育性髋关节脱位的关节镜下治疗_临床医学论文 【摘要】 探讨关节镜在小儿发育性髋关节脱位(DDH)治疗中的应用价值。［方法］所有患儿经理学检查、X线及螺旋CT诊断为DDH，并一部分为闭合复位再脱位，另一部分为难复位。将所有病人随机分两组：一组经关节镜治疗，21例，男7例,女14例，左侧14髋,右侧12髋，共26髋；年龄6～30个月,平均17.4个月。另一组为对照组，经Ferguson手术，25例，男8例，女17例，左侧16髋,右侧13髋，共29髋；年龄8～32个月,平均18.9个月。两组均清除妨碍复位的因素并使关节成形，复位石膏外固定10个月。［结果］按周永德评分标准，关节镜治疗组：优10髋，良 11髋，中3髋，差2髋。Ferguson手术组：优11髋，良10髋，中7髋，差1髋。两组间各级比较，统计学无显著性差异（Pgt;0.05）。［结论］关节镜在直视下观察并清除妨碍股骨头复位的因素,成形关节。此项技术,在一定条件下是可采纳的微创治疗DDH方法。 【关键词】 关节镜 发育性 髋脱位 Abstract: ［Objective］To evaluate the effect of arthrocopy on the treatment of developmental dislocation of the hips(DDH) in infants. ［Method］All the infants were diagnosed as having developmental dislocation of hip by physical examination, X-ray and CT. Some of them had redislocation after closed reduction, and others had refractory closed reduction. Patients were randomly classified into two groups. Group A underwent arthrocopic treatment. It included 21 infants with the ages of 6-30 months (M=7,F=14; 14 left and 12 right hips) .Group B underwent Ferguson treatment. It included 25 infants with the ages of 8～32 months (M=8,F=17; 16 left and 13 right hips ). The factors affecting hip reduction were removed thoroughly, and the hips were given a external fixation with plaster for 10 months.［Result］According to ZHOU Yong-de criterion, in group A, 10 cases were exellent,11 good, 3 fair, 2 poor, and in group B, 11 cases were exellent,10 good, 7 fair,1 poor.There was no significant difference between 2 groups（Pgt;0.05）.［Conclusion］The factors causing reductions should be removed arthroscopically. Arthrocopy may be a useful micro-treatment method for DDH. Key words：arthroscope; developmental; hip dislocation; infant; treatment 小儿发育性髋脱位（DDH）的主要治疗措施是手法复位。然而，当小儿（11～30个月）发育性髋脱位手法难复位或手法复位失败时，须改为手术切开治疗。而在此年龄中，其中一部分病人是采用Ferguson手术方法（切开手术），即通过对其髋臼内软组织清除、成型（如拉长的圆韧带，填塞的脂肪，纤维组织，内翻的盂唇等［1］），使头臼匹配，关节复位。然而，切开手术创伤较大，关节功能恢复较慢，且影响外观。髋关节镜技术［2］是近年来极具潜在临床价值一项新的微侵外科技术。作者自2003年3月～2006年2月采用关节镜对小儿发育性髋脱位选择性治疗21例，效果良好，认为可选择对低龄（小于