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目的探讨股骨粗隆下旋转缩短截骨在大龄儿童先天性髋脱位治疗中的临床疗效及意义。方法选择阜阳市第二人民医院2005年以来采用股骨粗隆下旋转缩短截骨联合pemberton手术治疗的29例(32髋)大龄儿童先天性髋脱位患儿的临床资料进行回顾性分析,对患儿术后1、3、6、12、24个月行X线片及CT检查,分析患儿股骨粗隆下截骨愈合时间,髋臼发育、股骨颈颈干角、骨颈前倾角以及股骨头包容发育情况,髋关节功能障碍以及股骨头坏死的发生率。结果本研究患儿均顺利完成手术,无切口感染、切口不愈合等并发症。随访1~6年,平均3年6个月,股骨粗隆下截骨全部骨性愈合,愈合时间2~4个月,平均3个月。股骨颈前倾角及颈干角发育良好,术后12个月前倾角及颈干角基本接近正常儿童。髋臼发育良好,股骨头包容满意,CE角及髋臼指数基本正常。29例(32髋)患儿中股骨头坏死5髋,占15.6%,髋关节屈曲<90°2髋,占6.25%。结论股骨粗隆下旋转缩短截骨在治疗大龄儿童先天性髋脱位术中具有重要意义,取得满意临床疗效,术后髋臼发育、股骨头包容、股骨颈前倾角、股骨颈干角发育良好,股骨头坏死率及髋关节僵硬率明显降低。
Objective To investigate the clinical effect and significance of rotation reduction and osteotomy of femur in treatment of children with congenital hip dislocation. Methods The clinical data of 29 cases (32 hips) older children with congenital dislocation of hip from the Second People ’s Hospital of Fuyang City from 2005 to 2005 were analyzed retrospectively. At 1, 3, 6, 12 and 24 months after operation, X-ray and CT examination were performed to analyze the healing time, acetabular development, femoral neck and neck anterior descendance, femoral head Inclusive development, hip dysfunction and the incidence of femoral head necrosis. Results The children were successfully completed surgery, no incision infection, incision nonunion and other complications. All cases were followed up for 1 to 6 years, with an average of 3 years and 6 months. All osteotomy of the femur was healed. The healing time was 2 to 4 months with an average of 3 months. The femoral neck anteversion and neck dry angle well developed, 12 months ago, the angle of inclination and neck angle close to normal children. Acetabular development, femoral head satisfaction, CE angle and acetabular index was normal. Of the 29 patients (32 hips), 5 had osteonecrosis of the femoral head, accounting for 15.6%, and hip flexion <90 ° 2 hips, accounting for 6.25%. CONCLUSIONS: Proximal femoral rotation and shortening osteotomy are of great significance in the treatment of children with congenital dislocation of the hip. Satisfactory clinical curative effect is obtained. The development of acetabulum, femoral head tolerance, anteversion of femoral neck, Femoral head necrosis and hip stiffness decreased significantly.