摘要
目的探讨关节镜辅助治疗难复性小儿发育性髋关节脱位(DDH)的适应证、手术方法及临床效果。方法2005年5月至2006年12月,共完成17例(23髋)关节镜下髋臼清理、盂唇成型、镜下复位术,其中男2例,女15例,年龄4～48个月(平均19.1个月),右侧14髋,左侧9髋,其中单髋11例,双髋6例。均为麻醉前、后闭合手法复位失败患者。采用髋关节前侧和大粗隆前方入路相结合,镜视下切除拉长、磨损的圆韧带、清理髋臼底部纤维脂肪组织、切除髋臼横韧带,除第1例采用盂唇内缘放射状切开外,其余均采用盂唇外2/3切开,关节镜监视下手法复位,必要时切断内收肌肌腱,髋屈曲外展稳定位置石膏外固定。结果全部23髋在关节镜下复位成功,随访12～31个月(平均25个月),除1例术前即有股骨头坏死外,全组患者无股骨头无菌性坏死发生。按全国先天性髋脱位疗效评定标准,优14髋,良1髋,可2髋,差6髋。分别测量成功组与失败组术前的前倾角、髋臼角、CE角及Zionts分级,进行统计学分析比较,两组术前前倾角、髋臼角的差异具有统计学意义,CE角及Zionts分级差异无统计学意义。结论在掌握好适应证的前提下,关节镜下髋臼清理、盂唇成型是辅助治疗小儿DDH的有效方法,与传统开放手术相比具有创伤小、恢复快的优点。前倾角小于40°、髋臼角小于35°是关节镜手术的适应证。术前的CE角及Zionts分级,对选择关节镜手术的适应证意义不大。盂唇外2/3的切开方式,有利于保持盂唇内缘的完整性,防治术后再脱位的发生。
Objective To explore the indication, operative technique and clinic effect of arthroscopy in the treatment of children developmental dysplysia of the hip （DDH） who had failed to be reduced by manipulative close reduction. Methods 17 cases （24 hips） of DDH were treated with debridement of the acetabulum and acetabular labrum plasty under the arthroscope. 2 cases were male, 15 were female, and the age varied from 4 to 48 months （ average 19.1 months）. 14 right and 9 left hips were involved. 11 cases were single hip dislocation and 6 were bilateral dislocation. Manipulative reduction under general anesthesia were tried and failed in all cases. Anterior and anterosuperior great trochanter portals were used to excise the hypertrophic, elongated and abrased ligamentum tere, fibrosis and fat tissues on the acetabular bottom were removed, the transverse ligament of acetabulum was resected also. At last the posterior outer two-thirds ram of labrum was incised except in the first case in whom the inner two-thirds ram was incised. Manipulative reduction and plaster cast immobilization within safe and stable position were done. Adductor tendon was released if necessary. Results Reduction was achieved successfully in all 23 hips and no avas- cular necrosis of the femoral head （ANF） occurred in duration of 12 to 31 months （ average of 25 months） postoperative follow-up except one who had suffered from ANF before the surgery. According to the national clinical outcome score scale of developmental dysplysia of the hip in children, excellent result was in 14 cases, good in 1, fair in 2 and poor in 6. Statistical analysis for the effective factors between successful group and failure group was carried out with anteversion, angulus acetabularis, center-edge angle and Zionts grade. The anteversion and angulus acctabularis had significant difference between two groups before surgery, but there were no statistical difference of the center-edge angle and Zionts grade between two groups. Conclusions Arthroscopically-assisted acetabular debridement and labrum plasty procedures are effective methods to help reduction in developmental dysplasia of the hip in children if appropriate indications are selected. Compared with the other open procedure, it has advantages of minimal invasion and faster wound healing. Base on our primary observation, less than 40 degree acetabular anteversion and less than 35 degree angulus acctabularis are implied to be good indications for arthroscopic surgery. Centeredge angle and Zionts grade before the surgery seems to be no affect on the surgical choice. Posterior two-thirds of outer-ram incision of the acetabular labrum is benefit for keeping the rest inner-ram integrity of the labrum which may prevent the femoral head redislocation from acetabulum.
出处
《中华关节外科杂志（电子版）》
CAS
2008年第4期33-37,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
