Shee B W, Huang S C, Liu T K
Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.
J Formos Med Assoc. 1993 Aug;92(8):729-36.
The value of preoperative traction of a neglected congenital dislocation of the hip (CDH) is a controversial issue. A retrospective study was performed to evaluate the effects of one-stage, total correction without traction used in neglected CDH. From April 1984 to November 1988, 64 patients (74 untreated dislocated hips) were operated upon with one-stage total correction without preoperative traction. Their ages ranged from 1 year 2 months to 8 years 6 months. Forty-five patients (53 hips) underwent open reduction and a Salter's osteotomy. Ten patients (11 hips) had additional femoral shortening. Nine patients (10 hips) underwent open reduction and a triple osteotomy with femoral shortening. With a minimum of two years of follow-up, all of the hips were well contained, except for two hips with subluxation and one hip with redislocation (reduced after a secondary operation). Avascular necrosis of the femoral head was evident in three hips (one in each group). All of the patients without complications functioned well without significant leg length discrepancy. The other patients also performed well after their complications were treated. In conclusion, neglected CDH in patients up to nine years of age can be safely and effectively treated by one-stage, total correction without preoperative traction.
对于 neglected 先天性髋关节脱位（CDH）术前牵引的价值是一个有争议的问题。进行了一项回顾性研究，以评估在 neglected CDH 中采用一期、无牵引全矫正的效果。1984 年 4 月至 1988 年 11 月，对 64 例患者（74 个未治疗的脱位髋关节）进行了一期无术前牵引的全矫正手术。他们的年龄从 1 岁 2 个月至 8 岁 6 个月不等。45 例患者（53 个髋关节）接受了切开复位和 Salter 截骨术。10 例患者（11 个髋关节）进行了额外的股骨缩短术。9 例患者（10 个髋关节）接受了切开复位和带股骨缩短的三联截骨术。经过至少两年的随访，除了两个半脱位髋关节和一个再脱位髋关节（二次手术后复位）外，所有髋关节均复位良好。股骨头缺血性坏死在三个髋关节中明显（每组一个）。所有无并发症的患者功能良好，无明显腿长差异。其他患者在并发症得到治疗后也表现良好。总之，9 岁以下患者的 neglected CDH 可以通过一期、无术前牵引的全矫正安全有效地治疗。
