述评
儿童发育性髋关节脱位开放复位术后的并发症及其处理
中华小儿外科杂志, 2019,40(12) : 1057-1061. DOI: 10.3760/cma.j.issn.0253-3006.2019.12.001
引用本文: 徐宏文, 黎艺强. 儿童发育性髋关节脱位开放复位术后的并发症及其处理 [J] . 中华小儿外科杂志, 2019, 40(12) : 1057-1061. DOI: 10.3760/cma.j.issn.0253-3006.2019.12.001.
参考文献导出:   Endnote    NoteExpress    RefWorks    NoteFirst    医学文献王
扫  描  看  全  文

正文
作者信息
基金 0  关键词  0
English Abstract
评论
阅读 0  评论  0
相关资源
引用 | 论文 | 视频

版权归中华医学会所有。

未经授权,不得转载、摘编本刊文章,不得使用本刊的版式设计。

除非特别声明,本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

发育性髋关节脱位(developmental dysplasia of the hip,DDH)是儿童骨科常见的下肢疾病,表现为股骨头和髋臼间位置关系的异常,包括髋臼发育不良、髋关节半脱位和全脱位,发病率约在1~34/1 000[1]。早期诊断和治疗对于提高DDH的治愈率、减少并发症具有重要意义。然而,由于目前我国还未广泛开展DDH早期筛查工作,我国DDH患儿年龄普遍偏大[2,3]。对于年龄大于2岁的患儿,多数学者建议行开放复位,必要时可一期行骨盆截骨和股骨短缩去旋转截骨术[4]。然而,开放复位和截骨矫形创伤较大,并发症发生率也会显著增加,如股骨头缺血性坏死(avascular necrosis of the femoral head,AVN)、再脱位、残余髋臼发育不良、关节僵硬、伤口感染、石膏压疮和神经血管损伤等[4,5]。本文将详细阐述DDH开放复位后的相关并发症,总结这些并发症的发生率、风险因素以及处理方法。

一、股骨头缺血性坏死

AVN是DDH治疗过程中最常见的并发症,在开放复位治疗的DDH中,既往学者报道的AVN发病率在1.6%~57.0%[6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]。其中纳入了100例以上DDH患儿的研究的AVN发生率在10.9%~42.9%,平均22.3%(662/2 958)[7]

影响DDH开放复位术后AVN发生率的因素很多。首先,开放复位本身就会显著增加AVN的风险[22,26]。Firth等[22]比较了行开放复位和闭合复位治疗DDH患儿的AVN发生率,结果行开放复位患儿的AVN发生率显著高于行闭合复位者。Wang等[26]的Meta分析纳入了7个对照研究,结果也提示行开放复位患儿的AVN发生率(20%)显著高于行闭合复位者(8%)。其次,其他因素如年龄[17,20,21]、脱位程度[7,17,20]、双侧脱位[20]、骨盆截骨和股骨截骨[5,21]、术后石膏固定外展角度大于60°等[18],也可能增加AVN的风险。Kothari等[5]的系统综述中纳入了18个研究,旨在探讨不同手术方式对开放复位治疗DDH后AVN发生率的影响,结果提示行单纯开放复位患儿的AVN发生率(4%)显著低于行开放复位+骨盆截骨(17%)、开放复位+股骨截骨(18%)、开放复位+股骨截骨+骨盆截骨(24%)的患儿。Pospischill等[21]的研究也显示,截骨矫形会显著增加AVN的发生率。可见,在开放复位治疗DDH时,除了疾病本身的病理改变会显著增加AVN的发生率以外,截骨矫形等医源性因素也是导致AVN的重要原因。

目前,对于DDH术后AVN的处理,国内外还没有一致意见。我们认为,需根据不同类型的AVN,采取不同的治疗策略。目前常用的AVN分型主要有Salter分型[27]、Bucholz and Ogden分型[28]和Kalamchi Mac-Ewen分型(K&M分型)[29]。近来,越来越多的研究者更倾向于使用K&M分型。可能是因为K&M分型具有更好的可靠性和可重复性,可以更好地判定AVN的严重程度[30]。对于K&M分型Ⅰ型的AVN,多数学者认为是股骨头暂时性的缺血改变,可以完全修复而不留后遗症,不用特别处理[31,32]。对于K&M分型Ⅱ型的AVN,主要的病理改变是股骨颈外侧生长紊乱,持续的股骨颈外翻畸形,从而导致股骨头覆盖不全和半脱位。Kim等[33]认为只有约一半K&M分型Ⅱ型的AVN能够获得满意的疗效。目前Ⅱ型AVN的常规治疗方法是行骨盆截骨或股骨内翻截骨术以改善股骨头的包容[34,35]。此外,近年来的部分研究显示,行经皮空心钉股骨颈内侧半骨骺阻滞可以改善股骨颈的外翻畸形[36,37]。对于K&M分型Ⅲ、Ⅳ型的AVN,可以通过骨盆截骨或股骨内翻截骨术改善股骨头包容,从而为股骨头的塑形提供良好的条件。不过由于K&M分型Ⅲ、Ⅳ型的AVN的股骨头破坏比较严重,很多患儿术后依然难以获得满意的影像学结果。

由此可见,AVN在开放复位治疗的DDH中发生率较高,年龄、脱位程度、双侧脱位、骨盆截骨和股骨截骨、术后石膏固定方式是导致AVN的重要风险因素。骨盆截骨、股骨内翻截骨以及经皮空心钉股骨颈内侧半骨骺阻滞术都能在一定程度上改善AVN的结局。

二、术后再脱位

再脱位在DDH开放复位术后相对少见,国内外报道其发生率在1.6%~10.9%,平均为2.9%(71/2 453)[7,10,17,19,21,25,38,39,40,41,42]。与再脱位有关的因素包括:年龄[43]、右侧或双侧脱位[41]、手术操作不当(包括内收肌、关节囊和髂腰肌处理不当、术中复位不佳、骨盆截骨和内固定操作不当、石膏固定外展角度过小)[38,41,43,44,45,46]。Sankar等[41]回顾性分析421例行切开复位治疗DDH的临床资料,其中25例出现再脱位,回归分析提示右侧或双侧脱位、骨盆宽度过大、石膏外展角度过小会显著增加再脱位的风险。此外,股骨头发育不良和过大的股骨颈前倾角也是导致再脱位的重要原因[41]。Tuhanioğlu等[47]也发现股骨颈前倾角过大是导致再脱位的原因。总体来说,多数学者认为再脱位的发生主要与手术操作不当有关。

研究显示,术后再脱位是导致DDH疗效变差的重要原因之一。因此,选择正确的手术方式和手术操作,预防再脱位,对于改善DDH的疗效具有重要意义[48]。这包括确切地暴露髋关节的真臼、完全松解阻挡复位的内收肌和髂腰肌腱、适当的骨盆和股骨截骨、适当的股骨去旋转、良好的复位、关节囊的处理以及石膏塑形[43,44,48]。一旦出现再脱位,须行CT或MRI检查,明确再脱位原因,尽快进行翻修手术。但如果再脱位发生在石膏拆除以后(一般术后2~3个月),则不建议此时立即进行翻修手术。因为此时往往伴随着关节僵硬、瘢痕增生及截骨部位骨质较差,不宜进行手术治疗,可等待3个月后再进行翻修手术。

三、残留髋臼发育不良

在DDH的治疗中,很多儿童骨科医生认为,一期切开复位加截骨矫形可以很好地矫正髋臼发育不良,从而避免二次手术。然而,既往的研究显示,切开复位截骨矫形后仍会有相当一部分患儿残留髋臼发育不良,平均20%患儿的髋关节在末次随访时影像学结果仍不满意(Severin Ⅲ/Ⅳ型)[6,7,8,13,14,15,16,17,19,20,24,49]。导致DDH切开复位后残留髋臼发育不良的因素有年龄[8,50]、AVN[8,12]及再脱位[51]。此外,手术操作不当,如截骨矫形不完全、植骨吸收、复位不佳等也可能导致残留髋臼发育不良。对于残留髋臼发育不良,往往需要进行二次截骨矫形。手术方式可以采用Salter截骨[52]、Pemberton截骨[53]或三联截骨矫形术[4,54]。目前,国内外有关二期截骨矫形治疗DDH开放复位后残余髋臼发育不良的研究较少,其手术疗效还有待进一步研究。

四、术后关节僵硬

临床上DDH开放复位后关节僵硬并不少见,特别是年龄大于6岁的患儿。张立军等[55]报道了开放复位治疗的551髋,有114髋(20.7%)出现关节僵硬。刘昆等[56]报道了41例(64髋)6岁以上的DDH,均采用开放复位截骨矫形进行治疗,总的关节僵硬发生率为42.2%。此外,还有部分文献也报道DDH开放复位术后有约20%左右的髋关节功能不满意[13,17,39,57,58]。可见DDH开放复位术后髋关节僵硬是常见的并发症。

研究显示,年龄是导致DDH切开复位术后髋关节僵硬的重要因素,年龄越大,就越可能出现髋关节僵硬[17]。此外,手术创伤是DDH术后关节僵硬的重要因素[56]。开放复位的同时,行骨盆截骨和股骨截骨也会显著增加髋关节僵硬的发生。此外,严重的股骨头坏死(K&M分型Ⅲ、Ⅳ型)也是导致髋关节僵硬的风险因素[24]

目前,DDH切开复位术后髋关节僵硬的治疗仍存在诸多困难。国内一些医院采用早期功能锻炼、手法康复治疗,甚至对于髋关节僵硬十分严重者采用手术松解[59,60]。此外,刘莹等[57]采用全身麻醉下手法关节授动治疗髋关节僵硬,也取得一定的疗效。不过由于他们的研究没有对照组,因此其疗效还有待进一步验证。

五、其他并发症

DDH开放复位术后的并发症除AVN、再脱位、残留髋臼发育不良及髋关节僵硬外,还有伤口感染、石膏压疮、截骨不愈合、股外侧皮神经和股神经麻痹、内植入物相关并发症等。在前期研究中,我们采用开放复位加Bernese骨盆三联截骨治疗20例(21髋)5岁以上DDH,结果有3例(14.3%)出现股外侧皮神经损伤,2例出现坐骨截骨不愈合(9.5%)[4]。Steel[54]及Lipton和Bowen[61]也报道了类似的结果。所有的这些并发症都需进行对症处理。

综上所述,DDH开放复位术后的各种并发症十分常见。其中,AVN的发生率约为23%,再脱位发生率约为3%,残留髋臼发育不良发生率约为20%,髋关节僵硬发生率在20%~30%。各种并发症的出现均可能导致治疗效果不满意。从目前仅有的2个长期随访研究结果来看,与闭合复位相比,开放复位治疗DDH并不能明显提高远期的临床疗效[62,63]。因此,我们认为,对于DDH患儿,我们应该采取更加保守的治疗方式。尽量避免破坏关节囊,并用二期截骨的方式处理残余髋臼发育不良,以最大限度地减少并发症的发生。

利益冲突
利益冲突

所有作者均声明不存在利益冲突

参考文献
[1]
KotlarskyPHaberRBialikVet al.Developmental dysplasia of the hip:What has changed in the last 20 years?[J].World J Orthop20156(11):886-901. DOI:10.5312/wjo.v6.i11.886.
[2]
LiY,ZhouQ,LiuY, et al. Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age[J]. Eur J Orthop Surg Traumatol, 2019, 29(1):51-57. DOI:10.1007/s00590-018-2289-5
[3]
LiYQGuoYMLiMet al.Acetabular index is the best predictor of late residual acetabular dysplasia after closed reduction in developmental dysplasia of the hip[J].Int Orthop201842(3):631-640. DOI:10.1007/s00264-017-3726-5.
[4]
LiYQXuHWSlongoTet al.Bernese-type triple pelvic osteotomy through a single incision in children over five years:a retrospective study of twenty eight cases[J].Int Orthop201842(12):2961-2968. DOI:10.1007/s00264-018-3946-3.
[5]
KothariAGrammatopoulosGHopewellSet al.How does bony surgery affect results of anterior open reduction in walking-age children with developmental hip dysplasia?[J].Clin Orthop Relat Res2016474(5):1199-1208. DOI:10.1007/s11999-015-4598-x.
[6]
Esmaeilnejad-GanjiSMEsmaeilnejad-GanjiSMRZamaniMet al.A newly modified salter osteotomy technique for treatment of developmental dysplasia of hip that is associated with decrease in pressure on femoral head and triradiate cartilage[J].Biomed Res Int201920196021271. DOI:10.1155/2019/6021271.
[7]
CastañedaPMasrouhaKZRuizCVet al.Outcomes following open reduction for late-presenting developmental dysplasia of the hip[J].J Child Orthop201812(4):323-330. DOI:10.1302/1863-2548.12.180078.
[8]
PolletVvan DijkLReijmanMet al.Long-term outcomes following the medial approach for open reduction of the hip in children with developmental dysplasia[J].Bone Joint J2018100-B(6):822-827. DOI:10.1302/0301-620X.100B6.BJJ-2017-0670.R2.
[9]
OzkutATIyetinYUnalOKet al.Radiological and clinical outcomes of medial approach open reduction by using two intervals in developmental dysplasia of the hip[J].Acta Orthop Traumatol Turc201852(2):81-86. DOI:10.1016/j.aott.2018.01.006.
[10]
刘柱李浩张志强一期联合手术治疗2~6岁发育性髋关节脱位儿童的临床和影像学结果评价[J].中华小儿外科杂志201738(7):511-515. DOI:10.3760/cma.j.issn.0253-3006.2017.07.006.
LiuZLiHZhangZQet al.Clinical and radiological outcomes of one-stage surgery for developmental dislocation of the hip in children[J].Chin J Pediatr Surg201738(7):511-515. DOI:10.3760/cma.j.issn.0253-3006.2017.07.006.
[11]
AlexievVGeorgievHMilevaSMiddle term results of simple open hip reduction of irreducible DDH - what is the cut-off age to safely perform it with lower complications?[J].Acta Chir Orthop Traumatol Cech201784(5):386-390.
[12]
GardnerROBradleyCSSharmaOPet al.Long-term outcome following medial open reduction in developmental dysplasia of the hip:A retrospective cohort study[J].J Child Orthop201610(3):179-184. DOI:10.1007/s11832-016-0729-5.
[13]
边臻朱振华郭源Salter截骨术与Pemberton截骨术治疗2~3岁发育性髋关节脱位的疗效分析[J].中华骨科杂志2015(9):935-941. DOI:10.3760/cma.j.issn.0253-2352.2015.09.008.
BianZZhuZHGuoYet al.Open reduction combined with Salter or Pemberton osteotomy and proximal femoral osteotomy for the management of developmental dislocation of the hip in children between the ages of 2 and 3 years[J].Chin J Orthop2015(9):935-941. DOI:10.3760/cma.j.issn.0253-2352.2015.09.008.
[14]
FarsettiPCateriniRPotenzaVet al.Developmental dislocation of the hip successfully treated by preoperative traction and medial open reduction:A 22-year mean followup[J].Clin Orthop Relat Res2015473(8):2658-2669. DOI:10.1007/s11999-015-4264-3.
[15]
张中礼杨建平龚仁钰切开复位骨盆Salter截骨术治疗发育性髋关节脱位的长期随访研究[J].中华骨科杂志2014(12):1183-1189. DOI:10.3760/cma.j.issn.0253-2352.2014.12.002.
ZhangZLYangJPGongRYet al.Long term results of open reduction and Salter osteotomy for developmental dislocation of the hip in children[J]. Chin J Orthop2014(12):1183-1189. DOI:10.3760/cma.j.issn.0253-2352.2014.12.002.
[16]
YamadaKMiharaHFujiiHet al.A long-term follow-up study of open reduction using Ludloff's approach for congenital or developmental dislocation of the hip[J].Bone Joint Res20143(1):1-6. DOI:10.1302/2046-3758.31.2000213.
[17]
NingBYuanYYaoJet al.Analyses of outcomes of one-stage operation for treatment of late-diagnosed developmental dislocation of the hip:864 hips followed for 3.2 to 8.9 years[J].BMC Musculoskelet Disord201415401. DOI:10.1186/1471-2474-15-401.
[18]
GardnerROBradleyCSHowardAet al.The incidence of avascular necrosis and the radiographic outcome following medial open reduction in children with developmental dysplasia of the hip:A systematic review[J].Bone Joint J201496-B(2):279-286. DOI:10.1302/0301-620X.96B2.32361.
[19]
AhmedEMohamedAHWaelHSurgical treatment of the late- presenting developmental dislocation of the hip after walking age[J].Acta Ortop Bras201321(5):276-280.DOI:10.1590/S1413-78522013000500007.
[20]
WangTMWuKWShihSFet al.Outcomes of open reduction for developmental dysplasia of the hip:Does bilateral dysplasia have a poorer outcome?[J].J Bone Joint Surg Am201395(12):1081-1086. DOI:10.2106/JBJS.K.01324.
[21]
PospischillRWeningerJGangerRet al.Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis?[J].Clin Orthop Relat Res2012470(1):250-260. DOI:10.1007/s11999-011-1929-4.
[22]
FirthGBRobertsonAJSchepersAet al.Developmental dysplasia of the hip:Open reduction as a risk factor for substantial osteonecrosis[J].Clin Orthop Relat Res2010468(9):2485-2494. DOI:10.1007/s11999-010-1400-y.
[23]
BollandBJWahedAAl-HallaoSet al.Late reduction in congenital dislocation of the hip and the need for secondary surgery:Radiologic predictors and confounding variables[J].J Pediatr Orthop201030(7):676-682. DOI:10.1097/BPO.0b013e3181efb8c7.
[24]
WuKWWangTMHuangSCet al.Analysis of osteonecrosis following Pemberton acetabuloplasty in developmental dysplasia of the hip:Long-term results[J].J Bone Joint Surg Am201092(11):2083-2094. DOI:10.2106/JBJS.I.01320.
[25]
ShihKS,WangJH,WangTM, et al. One-stage correction of neglected developmental dysplasia of the hip by open reduction and pemberton osteotomy[J]. J Formos Med Assoc, 2001, 100(6):397-402
[26]
WangYJYangFWuQJet al.Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip:A PRISMA-compliant meta-analysis of observational studies[J].Medicine (Baltimore)201695(29):e4276. DOI:10.1097/MD.0000000000004276.
[27]
SalterRBKostuikJDallasSAvascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children:A clinical and experimental investigation[J].Can J Surg196912(1):44-61.
[28]
BucholzRW,OgdenJA. Patterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. In: Proceodings of the Sixth Open Scientific Meeting of the Hip Society. St Louis: Mosby, 1978.
[29]
KalamchiAMacEwenGD.Avascular necrosis following treatment of congenital dislocation of the hip[J].J Bone Joint Surg Am198062(6):876-888.
[30]
OmerogluHTumerYBicimogluAet al.Intraobserver and interobserver reliability of Kalamchi and Macewen's classification system for evaluation of avascular necrosis of the femoral head in developmental hip dysplasia[J].Bull Hosp Jt Dis199958(4):194-196.
[31]
GageJRWinterRB.Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip.A critical review of twenty years' experience at Gillette Children's Hospital[J].J Bone Joint Surg Am197254(2):373-388.
[32]
SeverinE. Contribution to the knowledge of congenital dislocation of the hip joint[J]. Acta Chir Scand, 1941, 84(Suppl 63):1-142.
[33]
KimHWMorcuendeJADolanLAet al.Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis[J].J Bone Joint Surg Am200082(12):1692-1700. DOI:10.2106/00004623-200012000-00002.
[34]
Bar-OnEHuoMHDeLucaPA.Early innominate osteotomy as a treatment for avascular necrosis complicating developmental hip dysplasia[J].J Pediatr Orthop B19976(2):138-145.
[35]
LehmanWLGroganDP.Innominate osteotomy and varus derotational osteotomy in the treatment of congenital dysplasia of the hip[J].Orthopedics19858(8):979-986.
[36]
AgusHÖnvuralBKazimogluCet al.Medial percutaneous hemi-epiphysiodesis improves the Valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis[J].Acta Orthop201586(4):506-510. DOI:10.3109/17453674.2015.1037222.
[37]
ShinCHHongWKLeeDJet al.Percutaneous medial hemi-epiphysiodesis using a transphyseal screw for caput valgum associated with developmental dysplasia of the hip[J].BMC Musculoskelet Disord201718(1):451. DOI:10.1186/s12891-017-1833-5.
[38]
BhaskarADesaiHJainGRisk factors for early redislocation after primary treatment of developmental dysplasia of the hip:Is there a protective influence of the ossific nucleus?[J].Indian J Orthop201650(5):479-485. DOI:10.4103/0019-5413.189610.
[39]
李海冰李明瞿向阳切开复位、Salter骨盆截骨联合股骨近端旋转短缩截骨术治疗儿童发育性髋关节脱位的疗效分析[J].重庆医科大学学报201540(5):793-797. DOI:10.13406/j.cnki.cyxb.000551.
LiHBLiMQuXYet al.Open reduction,salter acetabular osteotomy,combined with proximal femoral rotation osteotomy in the treatment of pediatric developmental dysplasia of the hip[J].J Chongqing Med Univ201540(5):793-797. DOI:10.13406/j.cnki.cyxb.000551.
[40]
BhuyanBK.Outcome of one-stage treatment of developmental dysplasia of hip in older children[J].Indian J Orthop201246(5):548-555. DOI:10.4103/0019-5413.101035.
[41]
SankarWNYoungCRLinAGet al.Risk factors for failure after open reduction for DDH:A matched cohort analysis[J].J Pediatr Orthop201131(3):232-239. DOI:10.1097/BPO.0b013e31820c9b31.
[42]
刘志新先天性髋脱位前内侧入路切开复位远期疗效评价[J].中华小儿外科杂志199819(5):319. DOI:10.3760/cma.j.issn.0253-3006.1998.05.043.
LiuZX. Long-term outcome of congenital dislocation of the hip treated by anteromedial approach open reduction[J].Chin J Pediatr Surg199819(5):319. DOI:10.3760/cma.j.issn.0253-3006.1998.05.043.
[43]
吴伟平李旭燕华发育性髋关节脱位术后再脱位的原因分析与翻修策略[J].中国矫形外科杂志201927(1):11-15. DOI:10.3977/j.issn.1005-8478.2019.01.02.
WuWPLiXYanHet al.Cause and revision strategy of redislocation secondary to primary surgeries for development dislocation of the hip[J].Orthop J China201927(1):11-15. DOI:10.3977/j.issn.1005-8478.2019.01.02.
[44]
杨劼吕学敏李娜发育性髋关节发育不良切开复位、骨盆截骨术后再脱位的原因分析及手术治疗[J].骨科临床与研究杂志20194(3):143-147. DOI:10.19548/j.2096-269x.2019.03.004.
YangJLyuXMLiNet al.Analysis of reasons and surgical treatment for failure of open reduction and pelvic osteotomy in patients with developmental hip dislocation[J].J Clin Orthop Res20194(3):143-147. DOI:10.19548/j.2096-269x.2019.03.004.
[45]
唐学阳蒋欣王道喜发育性髋脱位切开复位手术失败及术后再脱位的原因分析[J].中华小儿外科杂志201031(3):195-199. DOI:10.3760/cma.j.issn.0253-3006.2010.03.011.
TangXYJiangXWangDXet al.The causes of operative failure after open-reductions of development dislocation of hips (DDHs)[J].Chin J Pediatr Surg201031(3):195-199. DOI:10.3760/cma.j.issn.0253-3006.2010.03.011.
[46]
ChidambaramSAbd HalimARYeapJKet al.Revision surgery for developmental dysplasia of the hip[J].Med J Malaysia200560(Suppl C):91-98.
[47]
TuhanioğluÜCicekHOgurHUet al.Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip[J].Hip Int201828(3):309-314. DOI:10.5301/hipint.5000571.
[48]
WedgeJHKelleySP.Strategies to improve outcomes from operative childhood management of DDH[J].Orthop Clin North Am201243(3):291-299. DOI:10.1016/j.ocl.2012.05.003.
[49]
GibsonPHBensonMK.Congenital dislocation of the hip.Review at maturity of 147 hips treated by excision of the limbus and derotation osteotomy[J].J Bone Joint Surg Br198264(2):169-175.
[50]
ChenQDengYFangBOutcome of one-stage surgical treatment of developmental dysplasia of the hip in children from 1.5 to 6 years old.A retrospective study[J].Acta Orthop Belg201581(3):375-383.
[51]
BaghdadiTBagheriNKhabiriSSet al.The outcome of salter innominate osteotomy for developmental hip dysplasia before and after 3 years old[J].Arch Bone Jt Surg20186(4):318-323.
[52]
SalterRB.Role of innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip in the older child[J].J Bone Joint Surg Am196648(7):1413-1439.
[53]
PembertonPA.Pericapsular osteotomy of the ilium for treatment of congenital subluxation and dislocation of the hip[J].J Bone Joint Surg Am19654765-86.
[54]
SteelHH.Triple osteotomy of the innominate bone.A procedure to accomplish coverage of the dislocated or subluxated femoral head in the older patient[J].Clin Orthop Relat Res1977(122):116-127.
[55]
张立军吉士俊刘卫东关节被动活动术治疗髋关节术后关节僵硬的理论与实践[J].中华骨科杂志1995(11):778-779.
ZhangLJJiSJLiuWDet al.The use of passive joint motion for the treatment of postoperative hip stiffness[J].Chin J Orthop1995(11):778-779.
[56]
刘昆梅海波伍江雁学龄儿童发育性髋关节脱位术后关节僵硬的前瞻性研究[J].临床小儿外科杂志20098(3):8-10. DOI:10.3969/j.issn.1671-6353.2009.03.003.
LiuKMeiHBWuJYet al.The prospective study to prevent stiffness of the hip in older children with developmental dislocation of the hip after operation[J].J Clin Pediatr Surg20098(3):8-10. DOI:10.3969/j.issn.1671-6353.2009.03.003.
[57]
刘莹王恩波史立伟全麻下手法关节授动治疗髋关节僵硬患儿193例[J].中国组织工程研究与临床康复200913(20):3997-4000. DOI:10.3969/j.issn.1673-8225.2009.20.041.
LiuYWangEBShiLWet al.Passive manipulation under general anesthesia for treating postoperative hip stiffness in193 children[J].J Clin Rehabilitative Tissue Eng Res200913(20):3997-4000. DOI:10.3969/j.issn.1673-8225.2009.20.041.
[58]
BarrettWPStaheliLTChewDE.The effectiveness of the Salter innominate osteotomy in the treatment of congenital dislocation of the hip[J].J Bone Joint Surg Am198668(1):79-87.
[59]
肖洪勋侯宗秀. 手法松解治疗小儿先天性髋关节脱位术后关节僵硬[J]. 中医正骨200214(4):41. DOI:10.3969/j.issn.1001-6015.2002.04.027.
XiaoHX,HouZX. Manipulation for post-operative joint stiffness in congenital dislocation of the hip[J]. J Tradit Chin Orthop Traumatol200214(4):41. DOI:10.3969/j.issn.1001-6015.2002.04.027.
[60]
张晶李春文张超小儿发育性髋关节脱位术后的康复训练探讨[J].中国伤残医学201725(20):99-100. DOI:10.13214/j.cnki.cjotadm.2017.20.062.
ZhangJLiCWZhangCPostoperative nursing intervention to the effects of joint movement function of children with developmental dislocation of the hip (DDH)[J].Chin J Trauma Disabil Med201725(20):99-100. DOI:10.13214/j.cnki.cjotadm.2017.20.062.
[61]
LiptonGEBowenJR.A new modified technique of triple osteotomy of the innominate bone for acetabular dysplasia[J].Clin Orthop Relat Res2005(434):78-85. DOI:10.1097/01.blo.0000163484.93211.94.
[62]
ThomasSRYW.Long-term outcome after anterolateral open reduction and Salter osteotomy for late presenting developmental dysplasia of the hip[J].J Child Orthop201812(4):364-368. DOI:10.1302/1863-2548.12.180076.
[63]
TerjesenTLong-term outcome of closed reduction in late-detected hip dislocation:60 patients aged six to 36 months at diagnosis followed to a mean age of 58 years[J].J Child Orthop201812(4):369-374. DOI:10.1302/1863-2548.12.180024.
 
 
展开/关闭提纲
查看图表详情
回到顶部
放大字体
缩小字体
标签
关键词