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目的通过对18个月以下与18~36个月两组髋脱位手法复位后髋关节形态发育情况进行回顾性研究,探讨18个月以上髋脱位手法复位的可行性。方法收集2003年1月至2007年12月,在复旦大学附属儿科医院接受内收肌切断、手法闭合复位、改良蛙式位(或蛙式位)石膏及外展支架固定治疗的36个月以下患儿78例(97髋),根据复位时年龄分为两组:<18个月组与≥18个月组(18~36个月)。通过骨盆平片上髋臼指数、髋关节内侧间隙、股骨头骨骺核、股骨头中心距离差及沈通线结合股骨头缺血性坏死与残余髋臼发育不良分别对手法复位后6、12、24、36个月髋关节形态变化进行复位后平均25.2(6~60)个月的随访观察。结果手法复位后髋臼指数及髋关节内侧间隙下降程度组间差异无统计学意义(P值分别为0.45,0.57,α=0.05);股骨头骨骺核发育情况组间差异无统计学意义(P=0.2,α=0.05);股骨头中心距离差下降水平组间差异亦无明显统计学意义(P=0.1349,α=0.05);沈通线在两组手法复位后都表现出一定的不稳定性:由复位前不连续,到复位后6个月支架拆除后连续,随着下地行走又欠连续。18~36个月组发生股骨头缺血性坏死率稍低于<18个月组(P=0.04,α=0.05),而残余髋臼发育不良率前组高于后组(P=0.01,α=0.05)。结论 18个月以上发育性髋脱位手法闭合复位治疗仍然可行。
Objective To retrospectively study the morphological changes of the hip joint after 18 months and 18 to 36 months of hip dislocation manipulation to explore the feasibility of reduction of hip dislocation by 18 months or more. Methods From January 2003 to December 2007, a total of 36 months of follow-up was performed at the pediatric hospital affiliated to Fudan University. The procedure was closed and closed, and modified frog-shaped (or frog-shaped) plaster and external fixation There were 78 children (97 hips), divided into two groups according to the age at reset: <18 months and> 18 months (18-36 months). Through the pelvic plain acetabular index, medial hip space, femoral epiphyseal nucleus, femoral head center distance difference and Shen Tong line combined with avascular necrosis of the femoral head and residual acetabular dysplasia, respectively, after the hand reset 6,12,24 , 36 months hip morphology changes were averaged 25.2 (6 ~ 60) months follow-up observation. Results There was no significant difference in the acetabular index and the reduction of the medial hip gap between the two groups (P = 0.45,0.57, α = 0.05, respectively). There was no significant difference in the development of the femoral head epiphyseal nucleus (P = 0.2, α = 0.05). There was no significant difference between the two groups (P = 0.1349, α = 0.05). Shen Tong line showed some instability Sex: Discontinuous before reset, to 6 months after the reset after the stent is removed continuously, with the continuous walking under the row. The incidence of avascular necrosis of femoral head in 18-36 months group was slightly lower than that in <18 months group (P = 0.04, α = 0.05), while the incidence of residual acetabular dysplasia in the former group was higher than that in the latter group (P = 0.01, α = 0.05). Conclusions Closed reduction of more than 18 months of developmental hip dislocation is still feasible.