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目的介绍Salter骨盆截骨术在学步期发育性髋关节脱位(DDH)患儿中的治疗指征和手术要点,探讨Salter骨盆截骨术早期干预“学步期”DDH患儿的重要意义。方法2002年12月～2005年12月,采用Salter骨盆截骨术治疗DDH患儿29例,3例为多关节挛缩。男8例,女21例;年龄12～18个月,平均16.59个月;双侧12例,左侧11例,右侧6例。共计手术31髋,全脱位25髋,半脱位6髋。所有病例完善术前检查后不作牵引直接行Salter骨盆截骨术。术后髋人字石膏固定2个月,双下肢皮肤牵引,床上关节活动1个月后下地负重行走。结果所有病例术后2个月,6个月,1年,之后每年1次连续随访。随访6～42个月,平均21.76个月。X线疗效按照Severin分级:Ⅰ级28髋,Ⅱ级3髋,Ⅲ级0髋。临床疗效优28髋,良3髋,可0髋,差0髋。结论根据国外的报道和我们的经验,对12～18个月处于“学步期”年龄段的全脱位和严重半脱位类型的DDH患儿采用Salter骨盆截骨术与保守治疗相比,可以在确保髋关节有效复位的同时,降低股骨头缺血坏死的发生率,避免二次手术,缩短疗程,对多关节挛缩髋脱位也具有良好的疗效,是一种安全、有效的手术方法。
Objective To introduce the treatment indications and operative points of Salter pelvic osteotomy in children with toddler developmental hip dislocation (DDH) and to discuss the significance of Salter pelvic osteotomy in children with DDH . Methods From December 2002 to December 2005, 29 children with DDH were treated with Salter pelvic osteotomy, and 3 patients were treated with multiarticular contracture. 8 males and 21 females; aged 12 to 18 months, with an average of 16.59 months; bilateral in 12 cases, left in 11 cases and right in 6 cases. A total of 31 hips surgery, total dislocation of 25 hips, subluxation 6 hips. Salter pelvic osteotomy was performed directly in all cases without improvement of preoperative examination. Postoperative hip gypsum fixed 2 months, double lower extremity skin traction, bed joint activity 1 month after the weight walking. Results All cases were followed up for 2 months, 6 months and 1 year after operation. Followed up for 6 ~ 42 months, an average of 21.76 months. X-ray efficacy according to Severin classification: Ⅰ grade 28 hips, Ⅱ grade 3 hips, Ⅲ grade 0 hips. Clinical efficacy of superior 28 hips, good 3 hips, 0 hips, 0 hips. Conclusions According to foreign reports and our experience, Salter pelvic osteotomy is better than conservative treatment in DDH children with complete dislocation and severe subluxation aged 12 to 18 months in the “Toddler” age group, It can reduce the incidence of avascular necrosis of the femoral head, prevent the secondary operation, shorten the course of treatment and also have a good curative effect on the multi-joint contracture hip dislocation while ensuring the effective reduction of the hip joint. It is a safe and effective surgical method.