Danielsson L
Department of Orthopedics, Malmö University Hospital, Sweden.
Acta Orthop Scand. 2000 Jun;71(3):232-42. doi: 10.1080/000164700317411816.
I have prospectively studied 71 consecutive patients (75 hips) with late-diagnosed DDH (developmental dysplasia of the hip) treated uniformly with special reference to the development of the femoral head and the acetabulum. The age at the start of treatment was 10 (2-64) months. The follow-up time was 11 (6-18) years. After tenotomy and traction, closed reduction failed in 7 hips. These cases were treated by open reduction with or without Salter innominate osteotomy-in 2 hips femoral osteotomy was also done (shortening, varus and derotation). 1 hip subluxated and 1 re-dislocated after closed reduction. Avascular necrosis occurred in 4 hips and additional surgery was required in 12 hips--11 Salter osteotomies, 1 varus femoral osteotomy. In the first year after reduction, the acetabular angle improved rapidly--faster in the younger children. When treatment started between 12 and 22 months, the improvement was slower and the final outcome more unpredictable. The femoral head continued to grow irrespective of the age at reduction and became normal in almost all cases. Salter's innominate osteotomy stabilized hips after open reduction and gave excellent results in cases with an increasing acetabular angle. At the last re-examination, all but 2 patients were asymptomatic. Radiographically, 65 hips were rated Severin group I, 9 group II and 1 group III.
我前瞻性地研究了71例连续的晚期诊断为发育性髋关节发育不良（DDH）的患者（75髋），特别关注股骨头和髋臼的发育情况。治疗开始时的年龄为10（2 - 64）个月。随访时间为11（6 - 18）年。在进行肌腱切断术和牵引后，7髋闭合复位失败。这些病例采用切开复位治疗，伴或不伴Salter骨盆截骨术——2髋还进行了股骨截骨术（缩短、内翻和旋转）。1髋在闭合复位后半脱位，1髋再脱位。4髋发生缺血性坏死，12髋需要额外手术——11例Salter截骨术，1例股骨内翻截骨术。复位后的第一年，髋臼角迅速改善——年幼儿童改善更快。当治疗在12至22个月开始时，改善较慢且最终结果更不可预测。无论复位时的年龄如何，股骨头继续生长，几乎所有病例最终都恢复正常。Salter骨盆截骨术在切开复位后稳定了髋关节，对于髋臼角增大的病例效果良好。在最后一次复查时，除2例患者外，所有患者均无症状。影像学上，65髋评为Severin I组，9髋为II组，1髋为III组。
