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先天性髋关节脱位不同治疗方法后髋臼发育的临床研究(作者译)

[A clinical study on the development of the acetabulum after various treatment in congenital dislocation of the hip (author's transl)].

作者信息

Kojima S

出版信息

Nihon Seikeigeka Gakkai Zasshi. 1979 Apr;53(4):383-402.

PMID:490003
Abstract

In the treatment of congenital dislocation of the hip, prognosis varies greatly according to the status of the development of the acetabulum. In most of the patients with osteoarthritis of the hip primary causes are found. In this series, 50% had congenital dislocation of the hip and 35% had acetabular dysplasia. In order to identify the conditions of hip joints in which the acetabular development can be expected from conservative treatment and to estimate the limit of age for indication of this treatment, the status of the development of the acetabulum was investigated after various treatment. This is expected to provide valuable data for the establishment of the method of treatment for cases without hope for the development of the acetabulum. According to the results, patients with acetabular angle of more than 30% at the age of 3 years have less possibility of normalization in the future and therefore active means for formation of the acetabulum should be considered in these patients. As such active means included are formation of the acetabulum through the pelvic osteotomy and the derotation-varus osteotomy are available in order to improve concentric position of the femoral head. It was also indicated that more favourable results could be obtained in patients who had undergone the pelvic osteotomy. The most favourable results were obtained in patients in whom both operations were used in combination. It was concluded from the results of the study that the best method is to perform the pelvic osteotomy first and to add the derotation-varus osteotomy as indicated.

摘要

在先天性髋关节脱位的治疗中,预后根据髋臼发育状况有很大差异。在大多数髋关节骨关节炎患者中可发现原发性病因。在本系列研究中,50%的患者患有先天性髋关节脱位,35%的患者有髋臼发育不良。为了确定哪些髋关节状况有望通过保守治疗实现髋臼发育,并评估该治疗的适用年龄界限,在各种治疗后对髋臼发育状况进行了调查。这有望为那些髋臼发育无望的病例提供有价值的数据,以确立治疗方法。根据结果,3岁时髋臼角超过30°的患者未来髋臼正常化的可能性较小,因此对于这些患者应考虑采用积极的髋臼成形方法。此类积极的方法包括通过骨盆截骨术和内旋-内翻截骨术来进行髋臼成形,以改善股骨头的同心位置。研究还表明,接受骨盆截骨术的患者能获得更理想的结果。同时采用这两种手术的患者效果最佳。根据研究结果得出结论,最佳方法是先进行骨盆截骨术,然后根据情况加做内旋-内翻截骨术。

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