Wenger Dennis R, Mubarak Scott J, Henderson Patrick C, Miyanji Firoz
Rady Children's Hospital-San Diego, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA ,
J Child Orthop. 2008 Jun;2(3):177-85. doi: 10.1007/s11832-008-0103-3. Epub 2008 Apr 29.
The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the early surgical descriptions of both the medial (Ludloff) approach and the anterior (Salter) approach to the hip, it was generally accepted that the ligamentum teres was an obstruction to reduction and was excised (similar to the discarding of menisci for knee surgery in our orthopedic history). Because of the known propensity for early re-dislocation following open reduction, we developed surgical methods for maintaining the ligamentum teres when performing open reduction for hip dislocation in young children. This study presents the surgical methods developed for ligament maintenance and transfer, and analyzes the early clinical and radiographic results in a study group.
The techniques for open reduction by both the medial Ludloff approach and the anterior open reduction were developed and refined. Twenty-one children (23 hips) had ligamentum teres shortening and transfer performed as part of either a medial Ludloff or anterior open reduction for hip dislocation. Complete pre-operative and post-operative clinical and radiographic analysis was performed.
All patients had stable hips at follow-up. The transferred ligamentum teres appeared to provide additional stability to prevent repeat dislocation. We noted no apparent loss of hip motion or other adverse events. One patient had avascular necrosis (AVN).
In this series of 23 hips, in which ligamentum teres transfer/tenodesis was utilized, we found no residual subluxation or dislocation in either the medial Ludloff or the anterior open reduction groups. Based on these early positive results, we recommend the method for children treated with the Ludloff open reduction procedure. Although we have less experience with it, the technique presented for ligamentum maintenance and transfer in anterior open reduction may provide similar added stability. This is an early follow-up study, and long-term follow-up will be required to confirm the ultimate femoral head and acetabular development.
圆韧带主要被认为是发育性髋关节脱位（DDH）患儿复位的阻碍。在早期关于髋关节内侧（Ludloff）入路和前方（Salter）入路的手术描述中，人们普遍认为圆韧带是复位的阻碍并将其切除（类似于我们骨科历史上膝关节手术中半月板的切除）。由于已知切开复位后早期再脱位的倾向，我们开发了在幼儿髋关节切开复位时保留圆韧带的手术方法。本研究介绍了为保留和转移韧带而开发的手术方法，并分析了一个研究组的早期临床和影像学结果。
开发并完善了内侧Ludloff入路和前方切开复位的技术。21例儿童（23髋）在进行内侧Ludloff或前方髋关节切开复位时，进行了圆韧带缩短和转移。进行了完整的术前和术后临床及影像学分析。
所有患者随访时髋关节均稳定。转移的圆韧带似乎提供了额外的稳定性以防止再次脱位。我们未注意到髋关节活动明显丧失或其他不良事件。1例患者发生了股骨头缺血性坏死（AVN）。
在这组23髋中，采用了圆韧带转移/固定术，我们在内侧Ludloff组或前方切开复位组均未发现残余半脱位或脱位。基于这些早期的阳性结果，我们推荐该方法用于接受Ludloff切开复位手术的儿童。虽然我们对此经验较少，但前方切开复位中保留和转移韧带的技术可能提供类似的额外稳定性。这是一项早期随访研究，需要长期随访以确认股骨头和髋臼的最终发育情况。
