髋关节发育不良合并股骨头缺血性坏死患儿的外科治疗-Eco-Vector.pdfVIP

原始论文 ORIGINAL PAPERS 25 /10.17816/PTORS7125-34 髋关节发育不良合并股骨头缺血性坏死患儿的外科治疗 Surgical treatment of children with hip dySplaSia complicated with avaScular necroSiS of the femoral head © M.P. Teplenky, E.V. Oleinikov, V.S. Bunov Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russia Received: 28.03.2018 Revised: 17.01.2019 Accepted: 05.03.2019 引言：股骨头缺血性坏死使髋关节发育不良外科治疗更加复杂，使预后更差。 目的：针对18例髋关节发育不良合并先天性股骨脱位闭合复位术后股骨头缺血性坏死患儿，研究其重 建手术的直接结局及中期结局。 材料与方法：患儿手术时平均年龄为4.2 ± 0.2岁。患儿被分为两组。第一组包括12例髋关节半脱位 患儿，其既往治疗包括关节各部位关节外重建、股骨头颈部脊柱通道建立与股骨颈硬件减压。第二组 包括6例既往接受切开复位术的髋关节脱位患者。采用D’Aubigne-Postel分类标准对关节功能结果进 行评估，而X线片评估则通过Kruczynski分类标准。 结果：观察期为3至7年不等（平均为4.2 ± 0.3年）。关节功能评估结果表明，第一组9例良好 （15至18分），第一组3例与第二组5例满意（12至14分），第二组1例不满意（11分）。X线片关节评 估结果表明，第一组6例良好，第一组6例与第二组5例满意，第二组1例不满意。 结论：关节外重建与刺激性干预联合硬件减压，能够帮助大腿髋关节半脱位合并缺血性坏死患儿改善 股骨头形状与结构，有利于关节面一致性的形成。 关键词：股骨头缺血性坏死；髋关节脱位；髋关节发育不良。 Introduction. Avascular necrosis of the femoral head complicates the surgical treatment of hip dysplasia and aggravates the prognosis. Aim. We studied the immediate and medium-term results of reconstructive treatment in 18 children with hip dysplasia complicated by avascular femoral head necrosis, which developed after closed repositioning of a congenitally dislocated femur. Material and methods. Average age at the time of operation was 4.2 ± 0.2 years. The patients were divided into two groups. Group 1 included 12 children with hip subluxation who underwent extra-articular reconstructions on articular components, spinal tunneling of the neck and head, and hardware unloading of the joint and group 2 included six patients with hip di