肱骨髁上骨折是儿童常见的骨折类型,好发于5~8岁儿童。目前,有移位的儿童肱骨髁上骨折首选闭合复位经皮克氏针内固定(closed reduction and percutaneous pinning,CRPP)治疗,其优点包括创伤小、疼痛轻、出血量少,可减少对骨折周围软组...肱骨髁上骨折是儿童常见的骨折类型,好发于5~8岁儿童。目前,有移位的儿童肱骨髁上骨折首选闭合复位经皮克氏针内固定(closed reduction and percutaneous pinning,CRPP)治疗,其优点包括创伤小、疼痛轻、出血量少,可减少对骨折周围软组织以及血运的破坏,且显著降低患肢感染的发生率。但是对于某些难复性GartlandⅢ型或GartlandⅣ型骨折,术中常因反复尝试闭合复位失败而迫使术者选择切开复位治疗,而该治疗方法可能增加并发症发生风险,导致患者预后不良。近年来,为提高闭合复位的成功率,诸多学者提出了多种经不同部位实施操纵杆辅助闭合复位治疗儿童肱骨髁上骨折的手术改进方案。本文就目前操纵杆技术的临床应用现状以及未来研究的方向进行综述。展开更多
发育性髋关节发育不良(development dysplasia of the hip, DDH),是儿童骨科常见的肌肉骨骼畸形之一,其发病的确切病因尚不明确,但是遗传因素和环境因素被认为在发病机制中起作用。其发病率存在地区差异和年龄差异,疾病的严重程度以及...发育性髋关节发育不良(development dysplasia of the hip, DDH),是儿童骨科常见的肌肉骨骼畸形之一,其发病的确切病因尚不明确,但是遗传因素和环境因素被认为在发病机制中起作用。其发病率存在地区差异和年龄差异,疾病的严重程度以及治疗方式的选择通过影像学分型来决定,如果没有合适的治疗,DDH儿童将影响正常行走功能以及过早产生骨关节炎,从而对生活质量产生重大影响。如今Pemberton截骨术治疗DDH被儿童骨科医生广泛采用,Pemberton截骨术不仅是一种实现髋臼形态矫正的技术,而且是可以联合其他术式以减少并发症的技术。本综述旨在总结Pemberton截骨术在DDH手术治疗中的应用及相关困难之处,以期为今后更加细节化的治疗提供参考。Developmental dysplasia of the hip (DDH) is one of the common musculoskeletal deformities in pediatric orthopedics. The exact cause of its onset is not yet clear, but genetic and environmental factors are believed to play a role in the pathogenesis. There are regional differences and age differences in its incidence rate. The severity of the disease and the choice of treatment methods are determined by the type of imaging classification. Without proper treatment, DDH children will affect their normal walking function and develop osteoarthritis prematurely, which will have a significant impact on the quality of life. Nowadays, Pemberton osteotomy is widely used by pediatric orthopedic surgeons to treat DDH. Pemberton osteotomy is not only a technique for correcting acetabular morphology, but also a technique that can be combined with other surgical procedures to reduce complications. This review aims to summarize the application and related difficulties of Pemberton osteotomy in the treatment of DDH surgery, in order to provide reference for more detailed treatment in the future.展开更多
青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis, AIS)是一种常见的青少年脊柱畸形,其特征是脊柱侧凸角度超过10˚,且椎体发生不明原因的旋转,形成二维或三维畸形。AIS患者在接受定制支具治疗或手术干预时,都需要定期进行放射学...青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis, AIS)是一种常见的青少年脊柱畸形,其特征是脊柱侧凸角度超过10˚,且椎体发生不明原因的旋转,形成二维或三维畸形。AIS患者在接受定制支具治疗或手术干预时,都需要定期进行放射学检查。而且,X线片的放射性可能导致人们担忧电离辐射增加癌症风险。超声作为一种普遍且必要的医学诊断和治疗工具,具有无辐射的优点。三维超声成像系统(Scolioscan)推动了无辐射脊柱成像技术的发展,为青少年脊柱侧凸的检查提供了一个优秀的替代方案。Adolescent Idiopathic Scoliosis (AIS) is a common adolescent spinal deformity characterized by a scoliotic angle of more than 10˚ and unexplained rotation of the vertebral bodies, resulting in a two- or three-dimensional deformity. Patients with AIS undergoing customized bracing or surgical interventions require periodic radiologic examination. Moreover, the radioactivity of radiographs may lead to concerns about increased cancer risk from ionizing radiation. Ultrasound, a common and necessary medical diagnostic and therapeutic tool, has the advantage of being radiation-free. The three-dimensional ultrasound imaging system (Scolioscan) has advanced the development of radiation-free spinal imaging and provides an excellent alternative to screening for adolescent scoliosis.展开更多
发育性髋关节发育不良(Developmental Dysplasia of the Hip,简称DDH)是是一种涉及髋关节结构异常和功能障碍的疾病,然而其具体发病机制及原因仍不清楚。其发病特征在于以髋关节发育不良为基础,导致关节囊松弛,股骨近端继发畸形,在髋臼...发育性髋关节发育不良(Developmental Dysplasia of the Hip,简称DDH)是是一种涉及髋关节结构异常和功能障碍的疾病,然而其具体发病机制及原因仍不清楚。其发病特征在于以髋关节发育不良为基础,导致关节囊松弛,股骨近端继发畸形,在髋臼对股骨头覆盖不良的情况下,逐渐出现股骨头脱位或半脱位于髋臼之外的下肢畸形。髋臼变浅以至于对股骨头覆盖降低是DDH引发髋关节不稳定进而引发青少年和青年期骨关节炎的重要原因。遗传和环境因素在DDH的发病机制中起重要作用。其发病机制和易感性相关基因尚未阐明。我们评估了PubMed数据库中索引的各种遗传学研究。我们分析了纳入研究的基本信息,并总结了DDH相关的突变位点,动物模型实验,与DDH相关的表观遗传学变化。展开更多
髋关节发育不良(Developmental Dysplasia of the Hip, DDH)是一种复杂的髋关节疾病,其涉及范围从新生儿的不稳定髋到髋臼或股骨的发育不良、髋关节半脱位直至完全脱位。这种疾病可能导致结构上的改变,从而引发早期的髋关节病变。尽管...髋关节发育不良(Developmental Dysplasia of the Hip, DDH)是一种复杂的髋关节疾病,其涉及范围从新生儿的不稳定髋到髋臼或股骨的发育不良、髋关节半脱位直至完全脱位。这种疾病可能导致结构上的改变,从而引发早期的髋关节病变。尽管已经确定了一些危险因素,但其确切的病因和病理生理机制仍未完全明了。新生儿筛查、体格检查以及超声检查在DDH的早期诊断和预防早期髋关节病变中起到了至关重要的作用。这篇综述着重总结了目前DDH的检测和治疗的实践策略。Developmental Dysplasia of the Hip (DDH) is a complex disease of the Hip, which involves from the unstable Hip to acetabular or femoral Dysplasia, subluxation and complete dislocation of the Hip. The disease can lead to structural changes that can lead to early hip disease. Although a number of risk factors have been identified, the exact etiology and pathophysiological mechanisms remain unclear. Neonatal screening, physical examination and ultrasonography play an important role in the early diagnosis and prevention of DDH. This review summarizes current practical strategies for the detection and treatment of DDH.展开更多
骨肉瘤(Osteosarcoma, OS)是一种起源于成骨细胞间充质细胞的肉瘤,最常见于15~19岁的儿童和青少年。目前的治疗策略包括化疗联合积极手术切除,已经显著提高骨肉瘤患者的生存率。但复发率仍为30%~40%,因肺转移10年生存率为20%~30%。化疗...骨肉瘤(Osteosarcoma, OS)是一种起源于成骨细胞间充质细胞的肉瘤,最常见于15~19岁的儿童和青少年。目前的治疗策略包括化疗联合积极手术切除,已经显著提高骨肉瘤患者的生存率。但复发率仍为30%~40%,因肺转移10年生存率为20%~30%。化疗是治疗骨肉瘤最有效的方法之一。然而,这些化疗药物由于获得耐药性和高剂量严重副作用而受到限制。近年来,微小RNA (MicroRNA, miRNA)分子作为恶性肿瘤的诊断和评估预后的重要组成部分,它们不但在真核基因表达调控中有着广泛的作用,而且还通过调控靶向因子对骨肉瘤细胞产生不同的影响,这也成为了探索骨肉瘤发生机制以及治疗策略的新思路。因此,本文就近年来几种常见miRNA的调控因子对骨肉瘤细胞所产生的影响进行总结,挖掘其在未来骨肿瘤疾病防治中的潜在价值。Osteosarcoma (OS) is a kind of sarcoma originating from osteoblast mesenchymal cells, which is most common in children and adolescents aged 15~19. Current treatment strategies, including chemotherapy combined with active surgical resection, have significantly improved the survival rate of osteosarcoma patients. But the recurrence rate is still 30%~40%, and the 10-year survival rate due to lung metastasis is 20%~30%. Chemotherapy is the most effective method to treat cancer and osteosarcoma. However, these chemotherapy drugs are limited by acquiring drug resistance and high dose of serious side effects. In recent years, MicroRNA (miRNA) molecules, as an important part of the diagnosis and prognosis evaluation of malignant tumors, not only play a wide role in the regulation of eukaryotic gene expression, but also have different effects on osteosarcoma cells by regulating targeting factors, which has become a new idea to explore the pathogenesis and treatment strategies of osteosarcoma. Therefore, this paper summarizes the effects of several common miRNA regulatory factors on osteosarcoma cells in recent years, and explores their potential value in the prevention and treatment of bone tumor diseases in the future.展开更多
发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是常见的儿童肢体畸形,早期筛查和诊断非常重要,延误治疗或治疗不当将导致严重后果。股骨头缺血性坏死(avascular necrosis,AVN)是DDH闭合复位后严重且常见的并发症,如何...发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是常见的儿童肢体畸形,早期筛查和诊断非常重要,延误治疗或治疗不当将导致严重后果。股骨头缺血性坏死(avascular necrosis,AVN)是DDH闭合复位后严重且常见的并发症,如何预防及避免AVN的发生一直困扰着小儿骨科医师。闭合复位前骨化核的存在似乎有助于降低AVN发生率,避免AVN的发生与DDH早诊断、早治疗关系密切。本文就骨化核与DDH闭合复位后AVN相关性的研究进展进行综述。展开更多
目的探讨观察加心理干预、石膏或支具固定以及手术治疗对儿童习惯性髋关节脱位(habitual dislocation of the hip,HDH)的临床疗效;采用系统文献复习的方法,探索HDH流行病学特征和维持髋关节稳定的治疗方案。方法回顾性分析2007年3月至2...目的探讨观察加心理干预、石膏或支具固定以及手术治疗对儿童习惯性髋关节脱位(habitual dislocation of the hip,HDH)的临床疗效;采用系统文献复习的方法,探索HDH流行病学特征和维持髋关节稳定的治疗方案。方法回顾性分析2007年3月至2021年3月治疗并获随访的11例(12髋)HDH患儿相关资料,其中男2例,女9例,首次脱位年龄2.25(1.66,3.75)岁,确诊时年龄4.33(3.33,6.17)岁。同时检索1932年至2022年相关文献,并依据纳入和排除标准确认24篇HDH个案和临床报道纳入研究,获得文献中33例(38髋)HDH患儿资料,男5例,女28例,首次脱位年龄2.00(1.50,2.00)岁,确诊时年龄4.00(2.55,5.00)岁。分析共计44例(50髋)HDH患儿性别、首次脱位年龄、确诊时年龄、激发脱位方式、脱位侧别和方向、伴随症状、家族史、外伤史、影像学检查等数据获得HDH流行病学特征。对41例HDH患儿(3例缺少治疗描述,被剔除),采取观察加心理干预19例(46.34%),石膏或支具固定13例(31.71%),手术治疗9例(21.95%)。对治疗前后骨盆正位X线片和髋关节脱位瞬间"真空现象"采用AutoCAD软件测量颈干角、髋臼指数、中心边缘角(central edge angle,CE角)、Reimers不稳定指数。采用Harris标准评价髋关节功能,同时记录脱位消失时间。结果44例(50髋)HDH患儿随访时间(4.05±2.93)年,治疗后脱位消失的时间(1.28±1.19)年。其中女37例,男7例;首次脱位年龄(2.64±1.54)岁,确诊时年龄(4.52±2.64)岁;右侧脱位30例,左侧8例,双侧6例;屈髋、内收、内旋或屈髋、内收作为激发脱位方式39例;后位脱43例;脱位时伴有响亮的"咔哒"声41例;无痛性脱位36例;脱位瞬间捕捉到真空现象37例。所有患儿均无特定家族史和明显外伤史。观察加心理干预组、石膏或支具固定组和手术治疗组患儿一般资料差异无统计学意义(P>0.05)。患侧脱位瞬间Harris标准评价髋关节功能、CE角和Reimers不稳定指数与治疗前和治疗后比较,差异有统计学意义(H=127.51,P<0.001;H=55.70,P<0.001;H=54.69,P<0.001)。与手术治疗组术后脱位即刻消失相比较,观察加心理干预组和石膏或支具固定组脱位消失时间明显延长,差异有统计学意义(H=20.83,P<0.001)。结论无特定家族史和明显外伤的幼儿期女孩,无痛性髋关节后脱位伴"咔哒"声以及脱位瞬间真空现象是HDH显著的流行病学特征;观察加心理干预、石膏或支具固定建议作为初始治疗方案,当保守治疗无效,需手术治疗迅速稳定髋关节。展开更多
文摘肱骨髁上骨折是儿童常见的骨折类型,好发于5~8岁儿童。目前,有移位的儿童肱骨髁上骨折首选闭合复位经皮克氏针内固定(closed reduction and percutaneous pinning,CRPP)治疗,其优点包括创伤小、疼痛轻、出血量少,可减少对骨折周围软组织以及血运的破坏,且显著降低患肢感染的发生率。但是对于某些难复性GartlandⅢ型或GartlandⅣ型骨折,术中常因反复尝试闭合复位失败而迫使术者选择切开复位治疗,而该治疗方法可能增加并发症发生风险,导致患者预后不良。近年来,为提高闭合复位的成功率,诸多学者提出了多种经不同部位实施操纵杆辅助闭合复位治疗儿童肱骨髁上骨折的手术改进方案。本文就目前操纵杆技术的临床应用现状以及未来研究的方向进行综述。
文摘发育性髋关节发育不良(development dysplasia of the hip, DDH),是儿童骨科常见的肌肉骨骼畸形之一,其发病的确切病因尚不明确,但是遗传因素和环境因素被认为在发病机制中起作用。其发病率存在地区差异和年龄差异,疾病的严重程度以及治疗方式的选择通过影像学分型来决定,如果没有合适的治疗,DDH儿童将影响正常行走功能以及过早产生骨关节炎,从而对生活质量产生重大影响。如今Pemberton截骨术治疗DDH被儿童骨科医生广泛采用,Pemberton截骨术不仅是一种实现髋臼形态矫正的技术,而且是可以联合其他术式以减少并发症的技术。本综述旨在总结Pemberton截骨术在DDH手术治疗中的应用及相关困难之处,以期为今后更加细节化的治疗提供参考。Developmental dysplasia of the hip (DDH) is one of the common musculoskeletal deformities in pediatric orthopedics. The exact cause of its onset is not yet clear, but genetic and environmental factors are believed to play a role in the pathogenesis. There are regional differences and age differences in its incidence rate. The severity of the disease and the choice of treatment methods are determined by the type of imaging classification. Without proper treatment, DDH children will affect their normal walking function and develop osteoarthritis prematurely, which will have a significant impact on the quality of life. Nowadays, Pemberton osteotomy is widely used by pediatric orthopedic surgeons to treat DDH. Pemberton osteotomy is not only a technique for correcting acetabular morphology, but also a technique that can be combined with other surgical procedures to reduce complications. This review aims to summarize the application and related difficulties of Pemberton osteotomy in the treatment of DDH surgery, in order to provide reference for more detailed treatment in the future.
文摘青少年特发性脊柱侧凸(Adolescent Idiopathic Scoliosis, AIS)是一种常见的青少年脊柱畸形,其特征是脊柱侧凸角度超过10˚,且椎体发生不明原因的旋转,形成二维或三维畸形。AIS患者在接受定制支具治疗或手术干预时,都需要定期进行放射学检查。而且,X线片的放射性可能导致人们担忧电离辐射增加癌症风险。超声作为一种普遍且必要的医学诊断和治疗工具,具有无辐射的优点。三维超声成像系统(Scolioscan)推动了无辐射脊柱成像技术的发展,为青少年脊柱侧凸的检查提供了一个优秀的替代方案。Adolescent Idiopathic Scoliosis (AIS) is a common adolescent spinal deformity characterized by a scoliotic angle of more than 10˚ and unexplained rotation of the vertebral bodies, resulting in a two- or three-dimensional deformity. Patients with AIS undergoing customized bracing or surgical interventions require periodic radiologic examination. Moreover, the radioactivity of radiographs may lead to concerns about increased cancer risk from ionizing radiation. Ultrasound, a common and necessary medical diagnostic and therapeutic tool, has the advantage of being radiation-free. The three-dimensional ultrasound imaging system (Scolioscan) has advanced the development of radiation-free spinal imaging and provides an excellent alternative to screening for adolescent scoliosis.
文摘发育性髋关节发育不良(Developmental Dysplasia of the Hip,简称DDH)是是一种涉及髋关节结构异常和功能障碍的疾病,然而其具体发病机制及原因仍不清楚。其发病特征在于以髋关节发育不良为基础,导致关节囊松弛,股骨近端继发畸形,在髋臼对股骨头覆盖不良的情况下,逐渐出现股骨头脱位或半脱位于髋臼之外的下肢畸形。髋臼变浅以至于对股骨头覆盖降低是DDH引发髋关节不稳定进而引发青少年和青年期骨关节炎的重要原因。遗传和环境因素在DDH的发病机制中起重要作用。其发病机制和易感性相关基因尚未阐明。我们评估了PubMed数据库中索引的各种遗传学研究。我们分析了纳入研究的基本信息,并总结了DDH相关的突变位点,动物模型实验,与DDH相关的表观遗传学变化。
文摘髋关节发育不良(Developmental Dysplasia of the Hip, DDH)是一种复杂的髋关节疾病,其涉及范围从新生儿的不稳定髋到髋臼或股骨的发育不良、髋关节半脱位直至完全脱位。这种疾病可能导致结构上的改变,从而引发早期的髋关节病变。尽管已经确定了一些危险因素,但其确切的病因和病理生理机制仍未完全明了。新生儿筛查、体格检查以及超声检查在DDH的早期诊断和预防早期髋关节病变中起到了至关重要的作用。这篇综述着重总结了目前DDH的检测和治疗的实践策略。Developmental Dysplasia of the Hip (DDH) is a complex disease of the Hip, which involves from the unstable Hip to acetabular or femoral Dysplasia, subluxation and complete dislocation of the Hip. The disease can lead to structural changes that can lead to early hip disease. Although a number of risk factors have been identified, the exact etiology and pathophysiological mechanisms remain unclear. Neonatal screening, physical examination and ultrasonography play an important role in the early diagnosis and prevention of DDH. This review summarizes current practical strategies for the detection and treatment of DDH.
文摘骨肉瘤(Osteosarcoma, OS)是一种起源于成骨细胞间充质细胞的肉瘤,最常见于15~19岁的儿童和青少年。目前的治疗策略包括化疗联合积极手术切除,已经显著提高骨肉瘤患者的生存率。但复发率仍为30%~40%,因肺转移10年生存率为20%~30%。化疗是治疗骨肉瘤最有效的方法之一。然而,这些化疗药物由于获得耐药性和高剂量严重副作用而受到限制。近年来,微小RNA (MicroRNA, miRNA)分子作为恶性肿瘤的诊断和评估预后的重要组成部分,它们不但在真核基因表达调控中有着广泛的作用,而且还通过调控靶向因子对骨肉瘤细胞产生不同的影响,这也成为了探索骨肉瘤发生机制以及治疗策略的新思路。因此,本文就近年来几种常见miRNA的调控因子对骨肉瘤细胞所产生的影响进行总结,挖掘其在未来骨肿瘤疾病防治中的潜在价值。Osteosarcoma (OS) is a kind of sarcoma originating from osteoblast mesenchymal cells, which is most common in children and adolescents aged 15~19. Current treatment strategies, including chemotherapy combined with active surgical resection, have significantly improved the survival rate of osteosarcoma patients. But the recurrence rate is still 30%~40%, and the 10-year survival rate due to lung metastasis is 20%~30%. Chemotherapy is the most effective method to treat cancer and osteosarcoma. However, these chemotherapy drugs are limited by acquiring drug resistance and high dose of serious side effects. In recent years, MicroRNA (miRNA) molecules, as an important part of the diagnosis and prognosis evaluation of malignant tumors, not only play a wide role in the regulation of eukaryotic gene expression, but also have different effects on osteosarcoma cells by regulating targeting factors, which has become a new idea to explore the pathogenesis and treatment strategies of osteosarcoma. Therefore, this paper summarizes the effects of several common miRNA regulatory factors on osteosarcoma cells in recent years, and explores their potential value in the prevention and treatment of bone tumor diseases in the future.
文摘发育性髋关节发育不良(developmental dysplasia of the hip,DDH)是常见的儿童肢体畸形,早期筛查和诊断非常重要,延误治疗或治疗不当将导致严重后果。股骨头缺血性坏死(avascular necrosis,AVN)是DDH闭合复位后严重且常见的并发症,如何预防及避免AVN的发生一直困扰着小儿骨科医师。闭合复位前骨化核的存在似乎有助于降低AVN发生率,避免AVN的发生与DDH早诊断、早治疗关系密切。本文就骨化核与DDH闭合复位后AVN相关性的研究进展进行综述。
文摘糖皮质激素被广泛用以抑制炎症和治疗各种炎症介导的疾病,能够深刻影响疾病进程,改善疾病症状并缩短病程[1]。然而,长时间使用糖皮质激素类药物可能导致很多严重并发症,其中激素性股骨头缺血性坏死(steroid-induced avascular necrosis of the femoral head,SANFH)是最常见的激素性骨坏死并发症。SANFH是由多种原因引发的股骨头局部血液供应受损导致骨细胞缺血缺氧、坏死和骨小梁断裂,继而发生股骨头塌陷的一种病变[2]。关于SANFH的发病机制有多种理论,包括细胞的自噬与凋亡、骨脂质代谢紊乱、血管内皮损伤、凝血异常、骨内高压和基因多态性等[3]。然而,SANFH的确切发病机制仍不明确。有研究结果表明,程序性细胞死亡(programmed cell death,PCD)的一种形式———细胞自噬与凋亡的部分信号通路相关基因在SANFH样本中过度表达[4]。PCD在SANFH的发生和发展中起到关键作用。PCD是一个由特定基因介导并调控的细胞(自发)死亡过程,在人体生长发育与疾病调节中起重要作用[5]。PCD在SANFH中的作用机制已成为研究的焦点。有学者发现某些特殊因素可通过干预PCD相关信号通路影响SANFH的发生,其确切机制仍待进一步研究。已有大量研究结果证实,糖皮质激素的副作用会导致细胞损伤,从而影响细胞的活力和生命力。有害刺激会诱发细胞内的抗损伤机制,导致细胞膜和线粒体损坏,使线粒体维持细胞生命活动的多种辅助功能失效,进而激活PCD机制。PCD是调控人体生长发育的重要机制之一,对其与激素性骨坏死关系的深入研究可以为发现激素性骨坏死的防治靶点提供理论基础。在此对PCD(凋亡型和自噬型)的发生机制、糖皮质激素诱发SANFH的复杂机制以及PCD(凋亡型与自噬型)在SANFH发生过程中的重要作用进行总结,以进一步了解骨细胞坏死机制,为探索SANFH的发病机制和临床治疗提供帮助。
文摘目的探讨观察加心理干预、石膏或支具固定以及手术治疗对儿童习惯性髋关节脱位(habitual dislocation of the hip,HDH)的临床疗效;采用系统文献复习的方法,探索HDH流行病学特征和维持髋关节稳定的治疗方案。方法回顾性分析2007年3月至2021年3月治疗并获随访的11例(12髋)HDH患儿相关资料,其中男2例,女9例,首次脱位年龄2.25(1.66,3.75)岁,确诊时年龄4.33(3.33,6.17)岁。同时检索1932年至2022年相关文献,并依据纳入和排除标准确认24篇HDH个案和临床报道纳入研究,获得文献中33例(38髋)HDH患儿资料,男5例,女28例,首次脱位年龄2.00(1.50,2.00)岁,确诊时年龄4.00(2.55,5.00)岁。分析共计44例(50髋)HDH患儿性别、首次脱位年龄、确诊时年龄、激发脱位方式、脱位侧别和方向、伴随症状、家族史、外伤史、影像学检查等数据获得HDH流行病学特征。对41例HDH患儿(3例缺少治疗描述,被剔除),采取观察加心理干预19例(46.34%),石膏或支具固定13例(31.71%),手术治疗9例(21.95%)。对治疗前后骨盆正位X线片和髋关节脱位瞬间"真空现象"采用AutoCAD软件测量颈干角、髋臼指数、中心边缘角(central edge angle,CE角)、Reimers不稳定指数。采用Harris标准评价髋关节功能,同时记录脱位消失时间。结果44例(50髋)HDH患儿随访时间(4.05±2.93)年,治疗后脱位消失的时间(1.28±1.19)年。其中女37例,男7例;首次脱位年龄(2.64±1.54)岁,确诊时年龄(4.52±2.64)岁;右侧脱位30例,左侧8例,双侧6例;屈髋、内收、内旋或屈髋、内收作为激发脱位方式39例;后位脱43例;脱位时伴有响亮的"咔哒"声41例;无痛性脱位36例;脱位瞬间捕捉到真空现象37例。所有患儿均无特定家族史和明显外伤史。观察加心理干预组、石膏或支具固定组和手术治疗组患儿一般资料差异无统计学意义(P>0.05)。患侧脱位瞬间Harris标准评价髋关节功能、CE角和Reimers不稳定指数与治疗前和治疗后比较,差异有统计学意义(H=127.51,P<0.001;H=55.70,P<0.001;H=54.69,P<0.001)。与手术治疗组术后脱位即刻消失相比较,观察加心理干预组和石膏或支具固定组脱位消失时间明显延长,差异有统计学意义(H=20.83,P<0.001)。结论无特定家族史和明显外伤的幼儿期女孩,无痛性髋关节后脱位伴"咔哒"声以及脱位瞬间真空现象是HDH显著的流行病学特征;观察加心理干预、石膏或支具固定建议作为初始治疗方案,当保守治疗无效,需手术治疗迅速稳定髋关节。
