发育性髋关节发育不良的切开复位失败后的翻修术。
Revision of Failed Open Reduction of Developmental Dysplasia of the Hip.
机构信息
Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
出版信息
Clin Orthop Surg. 2020 Dec;12(4):542-548. doi: 10.4055/cios19151. Epub 2020 Nov 18.
BACKGROUND
The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip.
METHODS
This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip (DDH).
RESULTS
According to the McKay clinical criteria, the results were good in 28 cases (82.4%), fair in 4 cases (11.8%), and poor in 2 cases with re-dislocation (5.9%). Radiological results according to the modified Severin criteria were as follows: 28 hips (82.4%) were identified as category 2 (good), 4 hips (11.8%) category 4 (fair), and 2 hips (5.9%) category 5 (poor).
CONCLUSIONS
Revision surgery for DDH is demanding and the long-term consequences are usually serious, but stable, concentric reduction should be obtained either at the first or second open reduction by addressing the causes of failure. Failed acetabulum remodeling and technical errors with inadequate soft-tissue release were the most common causes of failure in the primary operation. Based on the results, the outcome of revision surgery after failed open reduction for DDH was good.
背景
髋关节切开复位术后再脱位最常见的原因是显露不足和未能松解髋关节内及周围的阻碍性软组织。
方法
本临床研究纳入了 33 例（34 髋）DDH 切开复位失败后行翻修手术的儿童。
结果
根据 McKay 临床标准，28 例（82.4%）疗效良好，4 例（11.8%）疗效一般，2 例（5.9%）再脱位疗效差。改良 Severin 放射学标准评估结果如下：28 髋（82.4%）为 2 型（良好），4 髋（11.8%）为 4 型（一般），2 髋（5.9%）为 5 型（差）。
结论
DDH 的翻修手术要求高，长期后果通常严重，但应通过解决失败原因，在初次或第二次切开复位时获得稳定、同心的复位。初次手术中髋臼重塑失败和软组织松解不充分是导致失败的最常见原因。基于这些结果，DDH 切开复位失败后的翻修手术效果良好。
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