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目的探讨髋关节镜辅助治疗小儿发育性髋关节脱位(developmental dislocation of the hips,DDH)的临床效果。方法 2005年1月~2010年12月采用髋前侧及大粗隆前上入路髋关节镜技术完成16例(17髋)关节镜下增生滑膜刮除,股骨头圆韧带切除,髋臼底脂肪组织清理,髋臼横韧带松解,盂唇成形术,术毕髋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,如果髋臼角>25°二期行髋臼囊外截骨成形、股骨旋转(内翻、短缩)截骨等治疗。随访1年后每6个月随访1次,测量患儿骨盆髋臼角并进行Mckay和Severin评分。结果平均手术时间30.2 min(22~36 min),术中出血平均13.8 ml(10~25 ml),平均住院4.2 d(3~5 d)。16例(17髋)随访60~132个月(中位数91个月),按Mckay标准,优16髋,良1髋,优良率100%,按Severin标准,Ⅰ级13髋,Ⅱ级2髋,优良率88.2%(15/17)。结论髋关节镜技术可以使髋关节有效复位、刺激髋臼软骨发育,必要时配合行二期髋臼囊外截骨成形、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。
Objective To investigate the clinical effect of hip arthroscopy in the treatment of children with developmental dislocation of the hips (DDH). Methods From January 2005 to December 2010, 16 patients (17 hips) underwent arthroscopic hip arthroscopy and anterior approach to the greater trochanter for the treatment of hyperplastic synovial removals, resection of the femoral circumflex ligament, acetabulum Bottom fat tissue, acetabular transverse ligament release, labroplasty, surgical hip flexion outreach tube gypsum external fixation. Follow-up was performed at 3, 6, 9 and 12 months after operation. At 12 months of follow-up, if acetabulum angle> 25 °, acetabular extracapsular osteotomy, femoral rotation (varus, shortening) osteotomy treatment. Pelvis acetabular angle was measured and Mckay and Severin scores were measured in children at 1-year follow-up every 6 months. Results The average operation time was 30.2 minutes (22-36 minutes). The mean intraoperative bleeding was 13.8 ml (10-25 ml) and the average hospital stay was 4.2 days (3-5 days). Sixteen patients (17 hips) were followed up for 60 to 132 months (median, 91 months). According to the Mckay criteria, 16 were excellent and 1 was good with a good rate of 100%. According to the Severin criteria, grade I was 13 hips, grade II Hip, excellent and good rate was 88.2% (15/17). Conclusions Hip arthroscopy can effectively reset the hip joint and stimulate the development of acetabular cartilage. If necessary, it can be combined with the second stage acetabular extracapsular osteotomy. The femoral osteotomy (rotation, varus, shortening) Month DDH effective method. 2/3 incision outside the laminectomy surgery, leaving the inner edge intact, can effectively prevent postoperative dislocation.