关节囊成形联合骨盆截骨治疗大龄儿童先天性髋脱位△

Capsuloplasty combined with pelvic osteotomy for congenital hip dislocation in older children

摘要:

[目的] 介绍关节囊成形联合骨盆截骨治疗大龄儿童先天性髋脱位 （congenital dislocation of the hip, CDH） 的手术技术和初步临床结果。[方法]2017 年 9 月—2021 年 8 月联合应用 Colonna 关节囊成形术及 Chiari 骨盆内移截骨术治疗大龄儿童头臼不匹配型 CDH 患儿 19 例 19 髋。手术经 Bikini 入路显露髋关节囊前方，保护旋股内侧动脉升支，依次切开关节囊前方、 内缘下方、内缘上方及后方，松解臼底横韧带。修剪关节囊包裹股骨头，而后逐级扩臼以匹配头囊复合体。复位股骨头，行骨盆内移截骨术以获得满意覆盖。[结果]19 例患儿均获随访，随访时间平均（1.9±0.8）年。随访时 RI 为（0.02±0.06），CEA 为 （40.2±4.3）°。末次随访时患儿步态和关节功能均稳定，均未出现股骨头缺血坏死、断钉等并发症。根据改良 Severin 分类，优良率 84.2%。根据 McKay 标准，优良率 78.9%。[结论]联合应用 Colonna 关节囊成形术和 Chiari 骨盆内移截骨术治疗大龄儿童头臼不匹配型 CDH 早期效果良好。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of capsuloplasty combined with pelvic osteotomy for the treatment of congenital dislocation of the hip (CDH) in older children. [Methods] A total of 19 older children (19 hips) received Colonna capsuloplasty combined with Chiari pelvic osteotomy for mismatched CDH from September 2017 to August 2021. The Bikini approach was used to expose the anterior hip capsule and protect the ascending branch of the medial femoral circumflex artery. The capsule was cut at anterior surface, inferomedial margin, superomedial margin and posterior surface successively to release the transverse ligament at the base of the acetabulum. The capsule was trimmed to enclose the femoral head, and then acetabulum was reamed step by step to match the head capsule complex. Finally, the pelvic transverse transportation was conducted as pelvic osteotomy finished to enhance coverage of the head capsule complex. [Results] All the 19 patients were followed up for an average of (1.9±0.8) years. At the latest follow-up, RI was of (0.02±0.06), while the CEA was of (40.2±4.3)°. At the last follow-up, all children achieved stable gait and joint motion, and had no complications, such as avascular necrosis of the femoral head and implant broken. According to the improved Severin classification the excellent and good rate was of 84.2%, while based on the McKay creatria, the excellent and good rate of 78.9%. [Conclusion] The Colonna capsuloplasty combined with Chiari pelvic osteotomy for mismatched CDH in older children does achieve satisfactory early clinical outcome.