陈旧性髋关节脱位：罕见病例。我们应如何治疗？
Chronic hip dislocations: a rarity. How should we treat them?
作者信息
Selimi V, Heang O, Kim Y, Woelber E, Gollogly J
机构信息
University of Cambridge, Cambridge, England, United Kingdom.
Children's Surgical Centre, Phnom Penh, Cambodia.
出版信息
J Orthop. 2016 Sep 23;13(4):431-436. doi: 10.1016/j.jor.2016.09.002. eCollection 2016 Dec.
BACKGROUND
Chronically dislocated hips (>6 weeks) are usually the consequence of difficulties accessing appropriate healthcare in a timely fashion after dislocation; this explains why they are more common in developing countries. Due to a lack of research, there is currently no consensus on the best treatment available for patients presenting with this condition. Therefore, it is important to assess the treatments available so as to ensure that doctors adequately manage those presenting with this debilitating condition in the future.
OBJECTIVE
To identify the best treatment strategy for chronic hip dislocations based on the treatment outcomes achieved by a free surgical clinic in Phnom Penh, Cambodia.
PATIENTS AND METHOD
A retrospective analysis of the surgical centre's electronic records was conducted. Patients presenting with hips dislocated for >6 weeks were included whilst congenitally dislocated hips were excluded. Treatment outcomes, based on follow up notes, were then assessed. Data abstracted during chart review was analysed using descriptive and comparative statistics.
RESULTS
72 patients presented to the clinic with chronic hip dislocations. 42 patients received recorded treatment and 32 were followed up. Among patients with follow-up, 63% experienced 'good' outcomes after treatment. Open reductions, the most common treatment, were successful 65% of the time. The use of preoperative traction increased the success of open reductions by 13%, however, this result was not statistically significant ( = 0.64).
CONCLUSION
Open reductions with pre-operative traction seem to be an acceptable treatment in this setting.
背景
慢性髋关节脱位（超过6周）通常是脱位后未能及时获得适当医疗保健的结果；这解释了为什么在发展中国家这种情况更为常见。由于缺乏研究，目前对于患有这种疾病的患者的最佳治疗方法尚无共识。因此，评估现有的治疗方法很重要，以确保医生在未来能够妥善处理患有这种使人衰弱疾病的患者。
目的
根据柬埔寨金边一家免费外科诊所的治疗结果，确定慢性髋关节脱位的最佳治疗策略。
患者与方法
对该外科中心的电子记录进行回顾性分析。纳入髋关节脱位超过6周的患者，排除先天性髋关节脱位患者。然后根据随访记录评估治疗结果。在病历审查期间提取的数据使用描述性和比较性统计进行分析。
结果
72例患者因慢性髋关节脱位前来就诊。42例患者接受了有记录的治疗，32例进行了随访。在接受随访的患者中，63%在治疗后获得了“良好”的结果。切开复位是最常见的治疗方法，成功率为65%。术前牵引的使用使切开复位的成功率提高了13%，然而，这一结果在统计学上并不显著（P = 0.64）。
结论
在这种情况下，术前牵引的切开复位似乎是一种可接受的治疗方法。
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