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目的探讨关节镜在小儿发育性髋关节脱位(DDH)治疗中的应用价值。方法本组10例发育性髋关节脱位患儿,男2例,女8例;年龄8~26个月,平均13个月,单侧6例,双侧4例,共14侧髋。闭合复位外固定后再脱位4例5侧髋;闭合复位后安全角度小、不稳定4例6侧髋;闭合复位困难2例3侧髋。关节镜下观察妨碍复位的因素并清理髋臼。结果关节镜下观察到妨碍复位的主要因素有:盂唇增厚内翻5侧髋;圆韧带肥大4侧髋;髋臼横韧带增粗突出2侧髋;盂唇增厚内翻,圆韧带肥大与髋臼横韧带增粗突出同时存在3侧髋。所有病例髋臼内都有纤维脂肪组织充填。10例患儿复位外固定后髋关节位置好,CE角15.5°~18°(平均16.5°)。经平均随访38个月(29~54个月)无再脱位及股骨头无菌性坏死发生。结论关节镜可直视下观察妨碍股骨头复位的因素,彻底清理髋臼,提高了复位的成功率,降低了股骨头无菌性坏死的发生率,是一种较好的微创治疗DDH的方法。
Objective To investigate the value of arthroscopy in the treatment of children with developmental dislocation of the hip (DDH). Methods The group of 10 patients with developmental dislocation of the hip, 2 males and 8 females; aged 8 to 26 months, an average of 13 months, 6 cases of unilateral, bilateral in 4 cases, a total of 14 sides of the hip. After closed reduction and external fixation, dislocations were performed in 4 patients with 5 lateral hips. After closed reduction, the safety angle was small and unstable, with 6 lateral hips in 4 cases. Arthroscopic observation of the factors that impede the reset and clear the acetabulum. Results The main factors that obstruct the reduction were arthroscopic obstruction: 5 labial labrum thickened invertebrates, 4 round hips of round ligament hypertrophy, 2 thick lateral prominences of transverse ligament of acetabulum, thickening of labellum, round ligament Hypertrophy and transverse acetabular enlargement highlight the existence of 3 sides of the hip. All cases of acetabular fibrous tissue filled with fat tissue. In 10 cases, the position of hip joint was good after reduction and external fixation, and the angle of CE was 15.5 ° ~ 18 ° (average 16.5 °). After an average follow-up of 38 months (29 ~ 54 months) no dislocation and avascular necrosis occurred. Conclusion Arthroscopy can be observed under direct vision factors that prevent the reduction of femoral head, complete removal of the acetabulum, improve the success rate of reduction, reducing the incidence of aseptic necrosis of the femoral head is a better minimally invasive treatment of DDH method.