术前牵引及内侧切开复位成功治疗发育性髋关节脱位：平均22年随访
Developmental Dislocation of the Hip Successfully Treated by Preoperative Traction and Medial Open Reduction: A 22-year Mean Followup.
作者信息
Farsetti P, Caterini R, Potenza V, Ippolito E
机构信息
Department of Orthopaedic Surgery, University of "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
出版信息
Clin Orthop Relat Res. 2015 Aug;473(8):2658-69. doi: 10.1007/s11999-015-4264-3. Epub 2015 Apr 1.
BACKGROUND
During the last 35 years, the medial approach has been reported more frequently than the anterior approach for open reduction of developmental dislocation of the hip (DDH), however, few studies have followed children treated by medial open reduction to adulthood.
QUESTIONS/PURPOSES: The purposes of our study were: (1) to assess the development of 71 completely dislocated hips after medial open reduction, the incidence of additional surgery and avascular necrosis during the followup period, and the long-term radiographic and functional results; and (2) to compare our results with those obtained by others who performed open reduction either by the medial or anterior approach.
PATIENTS AND METHODS
We retrospectively evaluated, after the end of growth, 71 hips in 52 patients who underwent open reduction by the medial approach. The mean age of the patients was 16 months (range, 3-36 months). After surgery, the hips were immobilized in 100° flexion, 60° abduction, and neutral rotation for an average of 6 months. All patients had staged clinical and radiographic followups until skeletal maturity. The length of followup averaged 22 years (range, 13-32 years).
RESULTS
In all the surgically treated hips, the acetabular index normalized by the end of growth, the incidence of avascular necrosis was 18%, and additional surgery was required in 15% of our cases. At the last followup, 93% of the hips were classified as Severin Classes I or II and 7% as Class III; 76% of the hips had an excellent result, 17% had a good result, and 7% had a fair result according to the McKay scale as modified by Barrett and colleagues.
CONCLUSIONS
Open reduction of DDH through a medial approach provided good long-term radiographic and functional results in patients 3 to 36 months old and it was the only surgery performed in 85% of our cases. Future comparative studies are needed to confirm our results, especially in older children.
LEVEL OF EVIDENCE
Level IV, therapeutic study.
背景
在过去35年中，对于发育性髋关节脱位（DDH）切开复位术，内侧入路的报道比前侧入路更为频繁，然而，很少有研究对接受内侧切开复位术的儿童进行随访直至成年。
问题/目的：我们研究的目的是：（1）评估71例完全脱位髋关节内侧切开复位术后的发育情况、随访期间再次手术和股骨头缺血性坏死的发生率，以及长期影像学和功能结果；（2）将我们的结果与采用内侧或前侧入路进行切开复位术的其他研究结果进行比较。
患者和方法
我们在生长结束后对52例接受内侧入路切开复位术患者的71个髋关节进行了回顾性评估。患者的平均年龄为16个月（范围3 - 36个月）。术后，髋关节固定于屈曲100°、外展60°和中立旋转位，平均固定6个月。所有患者均进行了阶段性临床和影像学随访直至骨骼成熟。随访时间平均为22年（范围13 - 32年）。
结果
在所有接受手术治疗的髋关节中，髋臼指数在生长结束时恢复正常，股骨头缺血性坏死的发生率为18%，15%的病例需要再次手术。在最后一次随访时，93%的髋关节被分类为Severin I级或II级，7%为III级；根据Barrett及其同事修改后的McKay评分标准，76%的髋关节结果为优，17%为良，7%为中。
结论
对于3至36个月大的患者，通过内侧入路进行DDH切开复位术可提供良好的长期影像学和功能结果，并且在我们85%的病例中是唯一进行的手术。未来需要进行比较研究以证实我们的结果，尤其是对于年龄较大的儿童。
证据水平
IV级，治疗性研究。
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