Mitchell G P
Rev Chir Orthop Reparatrice Appar Mot. 1981;67(3):241-7.
Congenital dislocation of the hip in a child over the age of 4 may be discovered as a late untreated displacement, presenting with subluxation or dislocation, or as a late treated displacement presenting as a subluxating or subluxated hip. Conservative treatment is inadequate in untreated dislocations. Surgical reduction is the only possible procedure, associated with shortening femoral. The procedure may be used up to the age of 7 in bilateral cases, and up to the age of 12 in unilateral cases. Subluxating hips are recognised on the anteroposterior radiograph by a break in Shenton's line. A delayed Trendelenburg sign may also been seen. In such cases, innominate osteotomy or femoral derotation osteotomy should be performed, according to the anatomical defects present. Femoral shortening may be indicated in cases of increased length of the lower limb, associated with residual coxa valga or over growth following a previous rotation osteotomy to avoid the mechanical effects on the opposite hip. In cases of subluxated hip, varus upper femoral osteotomy may be indicated, or a Chiari osteotomy in painful hips. It is concluded that routine follow-up radiography is necessary, surgery being indicated as soon as a loss of acetabularcover of the femoral head is detected.
4岁以上儿童的先天性髋关节脱位可能表现为未经治疗的晚期移位，出现半脱位或脱位，或者表现为经治疗后的晚期移位，呈现为半脱位或已脱位的髋关节。对于未经治疗的脱位，保守治疗是不够的。手术复位是唯一可行的方法，会伴有股骨缩短。双侧病例该手术可在7岁前进行，单侧病例可在12岁前进行。在前后位X线片上，Shenton线中断可提示髋关节半脱位。也可能会出现延迟性Trendelenburg征。在这种情况下，应根据存在的解剖缺陷进行无名骨截骨术或股骨旋转截骨术。当下肢长度增加、伴有残余髋外翻或先前旋转截骨术后过度生长时，可能需要进行股骨缩短术，以避免对另一侧髋关节产生机械影响。对于髋关节半脱位的病例，可能需要进行股骨上段内翻截骨术，对于疼痛的髋关节则可进行Chiari截骨术。结论是，常规随访X线检查是必要的，一旦发现股骨头的髋臼覆盖丧失，应立即进行手术。
