• 四川大學(xué)華西醫(yī)院小兒外科（成都，610041）;

　　目的總結(jié)髖臼重建手術(shù)在兒童髖關(guān)節(jié)病理性脫位中的應(yīng)用及臨床療效。 方法2006年1月－2011年1月，共收治59例（59髖）兒童髖關(guān)節(jié)病理性脫位，采用髖關(guān)節(jié)切開(kāi)復(fù)位聯(lián)合髖臼重建手術(shù)治療。男22例，女37例；年齡1～15歲，平均4.9歲?；撔泽y關(guān)節(jié)炎后遺病理性脫位33例，髖關(guān)節(jié)結(jié)核26例；病程1個(gè)月～10年。髖關(guān)節(jié)半脫位9例，髖關(guān)節(jié)全脫位50例。術(shù)前Harris髖關(guān)節(jié)功能評(píng)分為43～78分，平均61分。14例髖臼指數(shù)基本正常，32例輕度增大，13例明顯增大。合并髖臼破壞28例；股骨頭缺血性壞死25例，股骨頭部分缺失12例，股骨頭完全缺失6 例，股骨頭頸同時(shí)缺失3例；前傾角增大25例；髖內(nèi)翻畸形9例。 結(jié)果術(shù)后即刻攝X線片示所有髖關(guān)節(jié)均達(dá)中心性復(fù)位。55例切口Ⅰ期愈合，4例切口延期愈合。53例獲隨訪，隨訪時(shí)間2～5年，平均3年。隨訪期間無(wú)髖關(guān)節(jié)再脫位。38例髖臼指數(shù)基本正常，15例輕度增大。前傾角15～25°，平均20°；頸干角110～140°，平均125°，頭頸解剖關(guān)系基本恢復(fù)正常。術(shù)后2年髖關(guān)節(jié)活動(dòng)度完全恢復(fù)正常18例，屈曲及旋轉(zhuǎn)輕度受限30例，纖維強(qiáng)直5例；Harris髖關(guān)節(jié)功能評(píng)分為 62～95分，平均87分。 結(jié)論兒童髖關(guān)節(jié)病理性脫位常合并嚴(yán)重的髖臼及股骨頭頸部骨質(zhì)破壞及后遺畸形，治療上應(yīng)嚴(yán)格遵循個(gè)體化原則，根據(jù)患髖主要病理改變選擇適當(dāng)?shù)捏y臼重建術(shù)式，并結(jié)合股骨頭頸重建處理，可獲得滿意療 效。

引用本文： 蔣欣,唐學(xué)陽(yáng),王道喜,陳小亮,劉芳,謝曉麗,劉利君,彭明惺. 髖臼重建手術(shù)在兒童髖關(guān)節(jié)病理性脫位的應(yīng)用. 中國(guó)修復(fù)重建外科雜志, 2012, 26(10): 1161-1165. doi: 復(fù)制

1. 董天華. 髖關(guān)節(jié)外科學(xué). 河南: 鄭州大學(xué)出版社, 2005: 343-363.
2. Moon MS, Kim SS, Lee SR, et al. Tuberculosis of hip in children: A retrospective analysis. Indian J Orthop, 2012, 46(2): 191-199.
3. 劉宏, 梅海波, 劉昆. 病理性髓關(guān)節(jié)脫位誤診為先天性髓關(guān)節(jié)脫位的分析. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 1998, 8(9): 39.
4. Harris WH. Traumatic arthritis of hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
5. Rebello G, Spencer S, Millis MB, et al. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res, 2009, 467(3): 724-731.
6. Hadadi A, Rasoulinejad M, Khashayar P, et al. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clin Microbiol Infect, 2010, 16(8): 1270-1273.
7. Teklali Y, El Alami ZF, El Madhi T, et al. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine, 2003, 70(4): 282-286.
8. 彭明惺, 劉利君, 張凌燕. 新生兒急性化膿性髖關(guān)節(jié)炎后遺病理性脫位的治療與預(yù)防. 中華骨科雜志, 2000, 20(10): 625-629.
9. 劉天婧, 石永言, 潘詩(shī)農(nóng), 等. Salter骨盆截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的中期隨訪. 中華外科雜志, 2010, 48(15): 1149-1153.
10. Wu KW, Wang TM, Huang SC, et al. Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip: long-term results. J Bone Joint Surg (Am), 2010, 92(11): 2083-2094.
11. Karlen JW, Skaggs DL, Ramachandran M, et al. The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop, 2009, 29(7): 676-682.
12. Varner KE, Incavo SJ, Haynes RJ, et al. Surgical treatment of developmental hip dislocation in children aged 1 to 3 years: a mean 18-year, 9-month follow-up study. Orthopedics, 2010, 10: 162-166.
13. Benum P. Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children. Acta orthopaedica, 2011, 82(1): 64-68.
14. Ryan MG, Johnson LO, Quanbeck DS, et al. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg (Am), 1998, 80(3): 336-344.
15. Spence G, Hocking R, Wedge JH, et al. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2009, 91(11): 2622-2636.
16. Oga M, Arizono T, Takasita M, et al. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976), 1993, 18(13): 1890-1894.
17. 于志勇, 李金戈, 尹紅義, 等. 活動(dòng)期髖、膝關(guān)節(jié)結(jié)核一期人工關(guān)節(jié)置換術(shù)的遠(yuǎn)期療效觀察. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2010, 25(6): 535-536.
18. 胡懿郃, 王賢, 李康華, 等. 化膿性髖關(guān)節(jié)炎后遺骨關(guān)節(jié)病的人工全髖關(guān)節(jié)置換治療. 中國(guó)修復(fù)重建外科雜志, 2007, 21(10): 1045-1049.
19. Wang Q, Shen H, Jiang Y, et al. Cementless total hip arthroplasty for the treatment of advanced tuberculosis of the hip. Orthopedics, 2011, 34(2): 90.
  1. 1. 董天華. 髖關(guān)節(jié)外科學(xué). 河南: 鄭州大學(xué)出版社, 2005: 343-363.
  2. 2. Moon MS, Kim SS, Lee SR, et al. Tuberculosis of hip in children: A retrospective analysis. Indian J Orthop, 2012, 46(2): 191-199.
  3. 3. 劉宏, 梅海波, 劉昆. 病理性髓關(guān)節(jié)脫位誤診為先天性髓關(guān)節(jié)脫位的分析. 中國(guó)現(xiàn)代醫(yī)學(xué)雜志, 1998, 8(9): 39.
  4. 4. Harris WH. Traumatic arthritis of hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
  5. 5. Rebello G, Spencer S, Millis MB, et al. Surgical dislocation in the management of pediatric and adolescent hip deformity. Clin Orthop Relat Res, 2009, 467(3): 724-731.
  6. 6. Hadadi A, Rasoulinejad M, Khashayar P, et al. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clin Microbiol Infect, 2010, 16(8): 1270-1273.
  7. 7. Teklali Y, El Alami ZF, El Madhi T, et al. Peripheral osteoarticular tuberculosis in children: 106 case-reports. Joint Bone Spine, 2003, 70(4): 282-286.
  8. 8. 彭明惺, 劉利君, 張凌燕. 新生兒急性化膿性髖關(guān)節(jié)炎后遺病理性脫位的治療與預(yù)防. 中華骨科雜志, 2000, 20(10): 625-629.
  9. 9. 劉天婧, 石永言, 潘詩(shī)農(nóng), 等. Salter骨盆截骨術(shù)治療髖關(guān)節(jié)發(fā)育不良的中期隨訪. 中華外科雜志, 2010, 48(15): 1149-1153.
  10. 10. Wu KW, Wang TM, Huang SC, et al. Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip: long-term results. J Bone Joint Surg (Am), 2010, 92(11): 2083-2094.
  11. 11. Karlen JW, Skaggs DL, Ramachandran M, et al. The Dega osteotomy: a versatile osteotomy in the treatment of developmental and neuromuscular hip pathology. J Pediatr Orthop, 2009, 29(7): 676-682.
  12. 12. Varner KE, Incavo SJ, Haynes RJ, et al. Surgical treatment of developmental hip dislocation in children aged 1 to 3 years: a mean 18-year, 9-month follow-up study. Orthopedics, 2010, 10: 162-166.
  13. 13. Benum P. Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children. Acta orthopaedica, 2011, 82(1): 64-68.
  14. 14. Ryan MG, Johnson LO, Quanbeck DS, et al. One-stage treatment of congenital dislocation of the hip in children three to ten years old. Functional and radiographic results. J Bone Joint Surg (Am), 1998, 80(3): 336-344.
  15. 15. Spence G, Hocking R, Wedge JH, et al. Effect of innominate and femoral varus derotation osteotomy on acetabular development in developmental dysplasia of the hip. J Bone Joint Surg (Am), 2009, 91(11): 2622-2636.
  16. 16. Oga M, Arizono T, Takasita M, et al. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976), 1993, 18(13): 1890-1894.
  17. 17. 于志勇, 李金戈, 尹紅義, 等. 活動(dòng)期髖、膝關(guān)節(jié)結(jié)核一期人工關(guān)節(jié)置換術(shù)的遠(yuǎn)期療效觀察. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2010, 25(6): 535-536.
  18. 18. 胡懿郃, 王賢, 李康華, 等. 化膿性髖關(guān)節(jié)炎后遺骨關(guān)節(jié)病的人工全髖關(guān)節(jié)置換治療. 中國(guó)修復(fù)重建外科雜志, 2007, 21(10): 1045-1049.
  19. 19. Wang Q, Shen H, Jiang Y, et al. Cementless total hip arthroplasty for the treatment of advanced tuberculosis of the hip. Orthopedics, 2011, 34(2): 90.