Brougham D I, Broughton N S, Cole W G, Menelaus M B
Royal Children's Hospital, Melbourne, Victoria, Australia.
J Bone Joint Surg Br. 1990 Jul;72(4):557-62. doi: 10.1302/0301-620X.72B4.2380203.
We studied the pathogenesis, incidence and consequences of avascular necrosis in 184 children treated for congenital dislocation of the hip. Of 210 hips, 99 (47%) had some evidence of avascular necrosis (total 81, partial 18). The incidence was not influenced by the age at reduction, the duration of traction or the use of adductor tenotomy. Patients treated by closed reduction without preliminary traction did not have a higher incidence of avascular necrosis. At long-term clinical and radiological review of 81 hips, early avascular necrosis significantly increased the chance of a poor outcome but did not predispose to acetabular dysplasia. If review includes minor forms of avascular necrosis, then this condition is common after closed reduction. Its presence is an important determinant of long-term radiological and clinical outcome.
我们研究了184例接受先天性髋关节脱位治疗的儿童发生缺血性坏死的发病机制、发病率及后果。在210个髋关节中，99个（47%）有缺血性坏死的某些证据（完全性81个，部分性18个）。发病率不受复位时年龄、牵引时间或内收肌切断术使用情况的影响。未经初步牵引而采用闭合复位治疗的患者，缺血性坏死的发病率并不更高。对81个髋关节进行长期临床和放射学评估时，早期缺血性坏死显著增加了预后不良的几率，但不会导致髋臼发育不良。如果评估包括轻微形式的缺血性坏死，那么这种情况在闭合复位后很常见。其存在是长期放射学和临床结果的重要决定因素。
