课件：发育性髋关节脱位英文.ppt

Treatment con’t Lovell and Winter judge stability at time of reduction and if stable observe for period of time for development if not developing properly with decreased acetabular index, teardrop then consider secondary procedure most common osteotomy is Salter or Pemberton anatomic deficiency is anterior and Salter provides this while Pemberton provides anterior and lateral coverage Natural Sequelae Goal of treatment is to have radiographically normal hip at maturity to prevent DJD after reduction achieved potential for development continues until age 4 after which potential decreases child 4 minimal dysplasia may observe but if severe than subluxations and residual dysplasias shoild be corrected when evaluating persistent dysplasia look at femur and acetabulum DDH deficiency usually acetabular side Residual Dysplasia plain xray with measurement of CE angle and acetabular index young children deficiency anterior and adolescents can be global deformities of femoral neck significant if lead to subluxation lateral subluxation with extreme coxa valga or anterior subluxation with excessive anteversion ( defined on CT ) usually DDH patients have a normal neck shaft angle Dysplasia for 2-3-years after reduction proximal femoral derotation or varus osteotomy should be considered if excessive anteversion or valgus prior to performing these be sure head can be concentrically reduced on AP view with leg abducted 30 and internally rotated varus osteotomy done to redirect head to center of acetabulum to stimulate normal development must be done before age 4 as remodeling potential goes down after this Adolescent or Adult Femoral osteotomy should only be used in conjunction with pelvic procedure as no potential for acetabular growth or remodeling but changing orientation of femur shifts the weightbearing portion Pelvic osteotomy considerations age congruent reduction range of motion degenerative changes Pelvic Procedures Redirectional Salter ( hinges on