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1、关节镜辅助治疗幼儿发育性體关节脱位长期随访报告徐会法黄鲁豫雷伟沙佳李超徐超严亚波李天清张春礼第四军医大学附属西京医院骨科摘要:目的探讨競关节镜辅助治疗小儿发育性競关节脱位(developmentaldislocationofthehips,DDH)的临床效果。方法2005年1月%10年12月釆用髓前侧及大粗隆前上入路髓关节镜技术完成16例(17髓)关节镜下增生滑膜刮除,股骨头圆韧带切除,髓臼底脂肪组织清理,髓臼横韧带松解,盂唇成形术,术毕髄屈曲外展位管型石膏外固定。术后3、6、9、12个月进行随访,随访12个月时,如果競臼角>25。二期行競臼囊外截骨成形、股骨旋转(
2、内翻、短缩)截骨等治疗。随访1年后每6个月随访1次,测量患儿骨盆骯臼角并进行Mckay和Severin评分。结果平均手术时间30.2min(22‘6min),术中出血平均13.8ml(1025ml),平均住院4.2d(35d)。16例(17W随访60!32个月(中位数91个月),按Mckay标准,优16髓,良1髓,优良率100%,按Severin标准,I级13髓,II级2競,优良率88.2%(15/17)。结论競关节镜技术可以使競关节有效复位、刺激髓臼软骨发育,必要时配合行二期髓臼囊外截骨成形、股骨截骨(旋转、内翻、短缩)是治疗年龄〈18个月DDH的有效方法。盂唇外
3、2/3切开的手术方式,保留内缘完整,能有效防止术后再脱位。关键词:骯关节镜;发育性骯关节脱位;骯臼截骨术;作者简介:黄鲁豫,E-mail:huangly@fmmu.edu.cn收稿日期:2016-10-18基金:国家自然科学基金资助项冃(项冃编号:81171735)ALong—termFollow-upofArthroscopic-assistedSurgeryforDevelopmentalDislocationofHipinInfantsXuHuifaHuangLuyuLeiWeiDepartmentofOrthopedics,XijingHospital,Fo
4、urthMilitatyMedicalUnivetsity;Abstract:ObjectiveToinvestigatetheclinicaleffectsofarthroscopic-assistedtreatmentofirreducibledevelopmentaldislocationofthehip(DDH).MethodsArthroscopic-assistedsurgerieswereperformedin19infants(21hips)undertheageof18monthsbetweenJanuary2005andDecember2010.
5、Anteriorandantero-superiorgreatertrochanteTapproacheswereusedintheseoperations,duringwhichthesynovialmembranewasresected,thefemoralheadligamentumtereswasexcised,thepulvinarwasremoved,thetransverseacetabularligamentwasreleased,andthelabrumwasfixed.Spicacastandabductionsplintwereapplledf
6、or3monthspostoperatively.Thefollow-upswereconductedonthe3rdmonth,6thmonth,9thmonthsand12thmonthpostoperatively.Duringthe12thmonth'sfollow-up,asecondarytreatmentsuchasacetabuloplastyand/orfemoralosteotomy(shorteningandderotation)wasappliediftheacetabularanglewasgreaterthan25°.After1-yea
7、rfollow-ups,allthechi1drenwerefollowedupeveryhalfayeartomeasurethechangesofpelvicacetabularanglethatwereevaluatedaccordingtotheMckayandSeverinstandards.ResultsAllthechildrenweretreatedwithanaverageoperationtimeof30.2min(range,22~36min),averageintraoperativebloodlossof13.8ml(range,10-