Gardner Richard O E, Worku Nardos, Nunn Timothy R, Zerfu Tewodros T, Kassahun Mesfin E
CURE Ethiopia Children's Hospital, Addis Ababa, Ethiopia.
J Pediatr Orthop. 2020 Aug;40(7):e554-e559. doi: 10.1097/BPO.0000000000001535.
Neglected traumatic hip dislocation in children is uncommon and there is no consensus on appropriate management. Previous studies report varied operative management with high rates of avascular necrosis and postoperative subluxation/dislocation. We report a series of 7 consecutive cases who underwent operative reduction after neglected hip dislocation and describe our technique for treatment.
All 7 children sustained posterior dislocations and had no treatment before presentation at our institution. An associated marginal acetabular fracture was present in 2 cases. One additional patient was excluded from the study due to complete loss of articular cartilage that precluded open reduction. The mean time before surgical intervention was 13.1 months (4 to 36 mo) with a mean age of 7 years (5.3 to 10.8 y). All children underwent preoperative skeletal traction for 10 to 14 days. A postero-lateral approach was used in all cases. The acetabulum was cleared of scar tissue and a femoral shortening performed as required (5 cases). Minor erosion of the articular cartilage of the posterior aspect of the femoral head was noted in 3/6 cases. After reduction, a posterior capsulorrhaphy was performed and the patient immobilized in a hip spica for 6 to 12 weeks.
The mean follow-up was 44 months (33 to 56 mo). The majority of children (86%) could walk and run without a limp, could squat, and had no pain. One child had mild pain and a limp. Mean Harris Hip Score was 98.9. No hip subluxed or dislocated postoperatively. The radiographs at latest follow-up showed no evidence of growth disturbance in 29% of cases, coxa magna in 57%, and partial femoral head collapse in 1 case (14%). Of note, those patients managed within 8 months of injury had none or minimal evidence of growth disturbance.
At medium-term follow-up, open reduction with a postero-lateral approach, posterior capsulorrhaphy, and femoral shortening (as required) produces a satisfactory outcome with a stable, congruent reduction. Good clinical function can be expected with a low incidence of avascular necrosis.
Level IV.
儿童创伤性髋关节脱位被忽视的情况并不常见，对于合适的治疗方法也没有达成共识。先前的研究报告了不同的手术治疗方法，其股骨头缺血性坏死和术后半脱位/脱位的发生率较高。我们报告了一系列连续7例被忽视的髋关节脱位后接受手术复位的病例，并描述了我们的治疗技术。
所有7名儿童均为后脱位，在我院就诊前均未接受治疗。2例伴有髋臼边缘骨折。另外1例患者因关节软骨完全丧失而无法进行切开复位，被排除在研究之外。手术干预前的平均时间为13.1个月（4至36个月），平均年龄为7岁（5.3至10.8岁）。所有儿童均接受了10至14天的术前骨骼牵引。所有病例均采用后外侧入路。清除髋臼内的瘢痕组织，并根据需要进行股骨缩短（5例）。6例中有3例注意到股骨头后侧关节软骨有轻微侵蚀。复位后，进行后侧关节囊缝合，患者髋人字石膏固定6至12周。
平均随访44个月（33至56个月）。大多数儿童（86%）能够行走和跑步而无跛行，能够蹲下且无疼痛。1名儿童有轻度疼痛和跛行。平均Harris髋关节评分为98.9。术后无髋关节半脱位或脱位。最新随访的X线片显示，29%的病例无生长紊乱迹象，57%有大转子增大，1例（14%）有股骨头部分塌陷。值得注意的是，那些在受伤后8个月内接受治疗的患者无生长紊乱迹象或仅有轻微迹象。
在中期随访中，采用后外侧入路切开复位、后侧关节囊缝合和根据需要进行股骨缩短，可获得满意的结果，复位稳定、匹配。预期临床功能良好，股骨头缺血性坏死发生率低。
四级。
