Laumonier F, Mallet J, Coupris L
Chir Pediatr. 1984;25(2):65-73.
The study concerns the results at the end of growth of an homogeneous series of congenital dislocation hips, treated by slow reduction, and secondary femoral neck osteotomy. Some of these hips were initially treated orthopaedically, others were operated for open reduction, more often, on account of a principle of treatment than due to necessity. The comparison of these two series allows the conclusion that the nocivity of the surgical procedure was demonstrated in most cases. The study demonstrated some harmful actions in the treatment of congenital dislocation hip at the age of walking. According to the authors, they aggravate the rate of deformities due to vascular lesions. The authors stress some therapeutic necessities, and describe their present attitude towards these hip dislocations. Their attitude is based upon a mild reduction, under progressive traction, abduction, and medial rotation. Tenotomies are, if necessary, performed previously. A plaster immobilization is then applied, until a sufficient penetration of the femoral head into covering acetabulum. In most cases, an abnormal femoral neck orientation was corrected by an osteotomy. An innominate osteotomy to improve the cover of the head was only performed when the centering of the head remained imperfect. By modifying an already ancient technique, which was proved by 84% good results in a series of 112 hips reviewed at the end of growth, the authors expect an actual decrease of the late trophic deformities.
该研究关注的是一系列先天性髋关节脱位经缓慢复位及二期股骨颈截骨术后的生长末期结果。其中一些髋关节最初接受骨科治疗,另一些则因治疗原则而非必要性接受切开复位手术。对这两组病例的比较得出结论:在大多数情况下,手术过程的有害性得到了证实。该研究表明,在患儿开始行走年龄阶段治疗先天性髋关节脱位存在一些有害作用。作者认为,这些有害作用会因血管病变而加剧畸形发生率。作者强调了一些治疗必要性,并描述了他们目前对这些髋关节脱位的治疗态度。他们的态度基于在逐渐牵引、外展和内旋下进行轻柔复位。如有必要,可预先进行肌腱切断术。然后应用石膏固定,直至股骨头充分嵌入髋臼。在大多数情况下,通过截骨术纠正异常的股骨颈方向。只有当股骨头的对合仍不理想时,才进行髋臼截骨术以改善股骨头的覆盖。通过改进一项已沿用很久的技术(在一组112例患儿生长末期复查中,该技术有84%的良好结果),作者期望实际减少晚期营养性畸形的发生。