摘要
目的探讨学龄儿童发育性髋关节脱位术后关节僵硬的原因。方法似设手术后创伤性炎症反应是引起学龄儿童发育性髋关节脱位术后关节僵硬的一个重要原因。本院2003年1月至2008年1月收治6岁以上发育性髋关节脱位患儿（Tonnis分级Ⅳ°）41例（64髋），年龄6～12岁，平均年龄8．2岁。均行髋关节切开复位，股骨、骨盆截骨术。采取前瞻性随机对照方法，分为研究组与对照组，研究组25例（39髋），其中双侧14例；男4例，女21例；对照组16例（25髋），其中双侧9例；男3例，女13例。术前均不做牵引，手术由同一主刀医生和相同手术组成员完成。研究组术后应用激素（地塞米松）和布洛芬5d。术后两组均予石膏固定6周，定期检查髋关节活动范围、骨盆及股骨近端截骨愈合速度与质量。结果所有病例均获随访，随访时间10个月至5年，平均32个月。疗效评价采用Mekay临床髋关节功能评定标准。研究组优5例7髋，良15例24髋，可3例5髋，差2例3髋；对照组优2例3髋，良6例10髋，可4例6髋，差4例6髋。两组各有1例1髋出现股骨头坏死。研究组髋关节轻度僵硬5例8髋，中度僵硬2例3髋，重度僵硬1例1髋；对照组髋关节轻度僵硬4例7髋，中度僵硬3例5髋，重度僵硬2例3髋；两组比较，差异有统计学意义（P〈0．05）。结论手术后创伤性炎症反应是引起学龄儿童发育性髋关节脱位术后关节僵硬的一个重要原因。术中尽量减轻创伤、术后短期使用地塞米松及非甾体抗炎药物能减轻手术后创伤性炎症反应，减少术后髋关节僵硬的发生。
Objective To investigate the role of the anti-inflammatory drugs for preventing stiffness of the hip in ohter ehildren with developmental dislocation of the hip （DDH） after operation. Methods Authors hypothesed that post-operative traumatic inflammatory response is an important factor causing the hip joint stillness in older children with DDH. Between January 2003 and January 2008,41 patients （64 hips,Tonnis grade Ⅳ°） were included in this study,aged from 6 to 12 years old,at a mean age of 8.2 years,who needed an open reduction with pelvic and proximal femoral osteotomies, were randomly divided into two groups ：study group and control group ,the study group 25 cases （39 hips）, 14 cases of bilateral ,four cases of male ,female 21 cases; the control group 16 cases （25 hips）,9 cases of bilateral,male 3 cases, 13 cases of female. No pre-operative traction was used and surgery performed by the same group of surgeons. Dexamethasone and ibuprofen were applied to the study group for five days after operation,Spica cast immobilization was used for 6 weeks, regular cheeks for the aetivities of the hip,X ray examination for the healing speed and quality of pelvis and proximal femoral osteotomy. Results All patients obtained clinical and radiographic follow-up averaging 32 months （range 10 months-5 years） from the time of surgery. The postoperative clinical scoring systerm by Mckay was used for evaluation. In the study group,there were excellent in live cases 7 hips,good in 15 cases 24 hips,fair in 3 caes 5 hips and poor results in2 caes 3 hips .In the control group, excellent in 2cases 3 hips, good in 6 cases 10 hips,fair in 4 eases 6 hips and poor in 4 cases 6 hips. Comparing the two groups,the incidence of hip joint stiffness in the study group was significantly lower than the control group, there was statistically significant （P 〈 0.05）. Conclusions Post-operative traumatic inflammatory response is an important factor for the hip joint stiffness in older children with DDH. Short-term use of dexamethasone and non-steroidal anti-inflammatory drugs could reduce the post-operative traumatic inflammatory response, so as to reduce or prevent the incidence of hip joint stiffness in older children.
出处
《临床小儿外科杂志》
CAS
2009年第3期8-10,共3页
Journal of Clinical Pediatric Surgery
