Gennari J M, Merrot T, Bergoin V, Turcat Y, Bergoin M
Department of Pediatric Surgery, CHU Nord, Chemin des Bourrely, Marseille, France.
Eur J Pediatr Surg. 1996 Oct;6(5):288-93. doi: 10.1055/s-2008-1066530.
Traumatic dislocations of the hip are much less frequent in children than in adults. If some complications are well known (avascular necrosis of the femoral head, recurrent dislocation), the lateralization of the head by x-ray transparency interposition is less appreciated. We report 4 cases of x-ray transparency interposition in 15 reductions of incomplete traumatic dislocation of the hip. These 4 dislocations were posterior in non-pathological hips, three on the left side and one on the right. Our reductions have been easy and the hips remained stable. However, the post-reduction roentgenogram shows the same unusual enlarged joint space corresponding to the lateralization of the femoral head. Four arthrotomies were performed, tracing a cartilaginous fragment free or fixed to the articular capsule into the femoral joint. We have found a concentric reduction of the hip in 4 cases and enlargement from 1 to 3 mm of the joint space of the hip. After several years, articular function of the four hips is normal, nevertheless, they have shown a coxa valga with a femoral elongation to 10 mm, a coxa magna with an articular space wider than 1 mm, 2 very good concentric reductions of the hip. The lateralization of the head after reduction had to be detected as soon as the first radiographic control because it can cause immediate instability or arthrosis of the hip. Because of the cartilaginous or capsular composition and the size of the interposition, an arthrotomy is performed in front of a radiological enlarging of the space joint, or a loss of parallelism of osteochondral acetabulum bone. Computerized tomography and MRI can reveal the nature, the place of the included fragment, as well as the surgical approach. An arthrogram is not absolutely indispensible. Surgical exploration should avoid degenerative arthrosis after a lateralisation left untreated.
儿童髋关节创伤性脱位比成人少见。虽然一些并发症广为人知（股骨头缺血性坏死、复发性脱位），但X线透光性插入导致股骨头外移却较少受到重视。我们报告了15例儿童髋关节不完全创伤性脱位复位中出现的4例X线透光性插入情况。这4例脱位均发生在无病变的髋关节，且为后脱位，左侧3例，右侧1例。我们的复位操作简便，髋关节保持稳定。然而，复位后的X线片显示关节间隙异常增宽，对应股骨头外移。我们进行了4次关节切开术，将游离或附着于关节囊的软骨碎片追踪至股关节内。我们发现4例髋关节均实现了同心复位，髋关节间隙增宽1至3毫米。数年后，这4个髋关节的关节功能正常，但均出现了髋外翻，股骨延长达10毫米，大转子增大，关节间隙增宽超过1毫米，其中2例髋关节实现了非常好的同心复位。复位后一旦首次影像学检查发现股骨头外移，就必须立即检测，因为这可能导致髋关节立即不稳定或发生关节炎。由于插入物的软骨或关节囊成分及其大小，在影像学显示关节间隙增宽或髋臼骨软骨平行性丧失时，应进行关节切开术。计算机断层扫描和磁共振成像可揭示嵌入碎片的性质、位置以及手术入路。关节造影并非绝对必要。手术探查应避免因未处理的外移而导致退行性关节炎。
