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目的:观察分析发育性髋关节脱位经闭合复位治疗后髋臼发育变化的规律以指导治疗。方法:本组对2006年以来获得随访的78例发育性髋关节脱位患儿分为大小年龄组,均给予闭合复位治疗,其中连衣挽具治疗18例;可调式铝架治疗60例,于复位前、复位后动态测量患、健侧髋关节的髋臼指数[acetabular index,AI]和髋臼深度与宽度比值[acetabular index of depth to width,AI(D/W)],并进行相关比较。结果:根据周永德发育性髋脱位疗效评价标准,治疗12个月功能恢复总优良率达88.46%。脱位髋关节经闭合复位各项指标的改变分别为:患侧AI由治疗前(33.75±4.60)°下降至(24.50±6.35)°,AI(D/W)由(12.20±4.65)%增长至(20.10±3.45)%,患侧AI下降幅度、AI(D/W)增长幅度明显快于健侧(P<0.01)。在AI的回复过程中,大龄组和小龄组间存在明显的差别。结论:闭合复位治疗发育性髋关节脱位操作简便,对2～24个月DDH患儿是一种有效的治疗方法,治疗效果良好,其中股骨头复位是刺激AI下降和AI(D/W)增加的主要因素,在治疗后12个月内,患侧髋臼发育速度明显快于健侧。患儿年龄≤18个月为治疗发育性髋关节脱位的最佳时期。
OBJECTIVE: To observe and analyze the regularity of development of acetabulum after closed reduction in developmental dislocation of the hip to guide the treatment. Methods: This group of 78 patients with developmental hip dislocation who were followed up since 2006 were divided into size and age groups, and were treated with closed reduction treatment, of which 18 were treated with harness and harness, 60 were treated with adjustable aluminum frame, Before reset, the acetabular index (AI) and the acetabular index of depth to width (AI (D / W)] of the hip joint were measured dynamically after reduction and compared. . Results: According to Zhou Yongde evaluation criteria of developmental dislocation of hip disability, the total excellent and good rate of functional recovery at 12 months was 88.46%. The changes of the parameters of closed reduction and reduction of dislocated hip were as follows: the ipsilateral AI decreased from (33.75 ± 4.60) ° to (24.50 ± 6.35) ° and AI (D / W) increased from (12.20 ± 4.65)% to (20.10 ± 3.45)%, ipsilateral AI decreased, AI (D / W) increased significantly faster than the contralateral (P <0.01). There was a clear difference between the older and younger age groups in the AI response. Conclusion: Closed reduction is a simple and convenient method for the treatment of dislocated hip joint. It is an effective treatment for children with DDH from 2 to 24 months, and the treatment effect is good. The reduction of femoral head is the reduction of AI and the increase of AI (D / W) Of the main factors in the 12 months after treatment, ipsilateral acetabulum development was significantly faster than the contralateral. Children aged ≤ 18 months for the development of the best period of dislocation of the hip.