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題名 | Surgical Treatment of Untreated Congenital Dislocation of the Hip: Experience on 31 Hips in Jeddah General Hospital=先天性髖關節脫臼之外科治療--在吉達醫院31例之經驗 |
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作者 | 黃世傑; 侯勝茂; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 16:2 1983.06[民72.06] |
頁次 | 頁152-165 |
分類號 | 416.61 |
關鍵詞 | 先天性髖關節脫臼; 外科治療; |
語文 | 英文(English) |
中文摘要 | 在過去的1年9個月的時間內,作者在沙烏地阿拉伯王國吉達總醫院共為19人先天性髖關節脫臼施行31個體部手術治療。這些治療包括作者所做的初步手術及發生併發症後的再度手術,共計有:1個開刀復位術,25個Salter氏切骨術其中5個合併股骨切骨術,2個Pemberton氏切骨術,2個triple切骨術其中1個合併股骨切骨術,以及1個股骨切骨術。所有31個髖部手術,只有2例未將關節打關。 早期的併發症有3例再脫臼、5例半脫臼、3例輕度的缺血性壞死、1例髖關節僵硬症、1例釘道感染症、以及1例coxa vara畸形。3個再脫臼已分別經由閉式復位、開刀復位、以及開刀復位合併股骨切骨術得到治療;1例半脫臼亦再接受開刀復位及Salter氏切骨術;因釘子外露導致傷口肉芽組織形成之病例,其傷口則重新修補過。在平均6點7個月的追踪期間內,其初步的結果相當不錯。 根據本研究的經驗,過頭式皮膚牽引術對於17個月到2歲半大的小孩,其促進復位的作用甚差。骨骼牽引對年齡較大的小孩相當有效,但却合併有釘道感染、骨骼傷害及骨質疏鬆之後遺症。故若在手術時放鬆關節附近的軟組織,必要時再加上股骨縮短術,則年齡較大的小孩可不必作術前牽引,如此其住院時間也可跟大大地縮短。 體臼重建手術乃是以透明軟骨作為負重面,如果病人能符合其適應症及先決條件,就予以優先考慮此種手術。否則只好考慮其他之補救手術,如此至少在將來若要換全人工髖關節時,能提供較好附著處。 由於客觀環境不佳及初期經驗不足,以致於併發症之發生率不算很低,在31個髖部手術中有14個併發症。檢討起來,如果手術時關節被囊整形術能做得好,在縫合傷口及包石膏時,能把關節位置維持好,那麼再脫臼的情況就可以避免了;若是骨盆切骨術轉位足夠,用以固定的釘子不滑掉,術後半脫臼的現象也必定會大大減少;而且,應隨時防止手術中對血管的傷害,以及避免術前牽引及術後包石膏時探取過度的姿勢,這些都是造成股骨頭缺血性壞死的因素。假如關節需再手術但仍僵硬時,則時間一定要延後才行。最後要注意的就是不管是用釘子或鋼板來固定切骨的地方,一定要穩固才行,否則切骨處就可能會移位或變形了。上述諸點若能把喔,則發生併發症的可能性就可大大地降低了。 任何併發症均應及早發現,並給予適當之治療,以求較佳的結果,若要對可能的後遺症給予適切的治療,並對治療結果作最後判定,長期的追踪乃屬必要。如何做好早期病例發現,尋求最佳的治療方法,以及肪止併發症尤其是缺血性壞死之發生,仍然是目前最重要的課題。 |
英文摘要 | During the past one year and 9 months, the authors had performed operative treatment for congenital dislocation of the hip (CDH) on 31 hips in 19 patients in Jeddah General Hospital. The treatment included the primary and secondary operations, and there were one open reduction, 25 Salter's osteotomies with 5 adjunctive femoral osteotomies, 2 Pemberton's osteotomies, 2 triple osteotomies with one adjunctive femoral osteotomy, and one femoral osteotomy. The joint wasn't open in only two of the 31 joints. The early complications consisted of 3 redislocations, 5 subluxations, 3 mild ischemic necrosis, one joint stiffness, one pin tract infection, and one coxa vara deformity. The 3 redislocations were reducedby closed reduction, open reduction and open reduction with femoral osteotomy respectively; One subluxation was operated again with open reduction and Salter's osteotomy; Wound revision was done for the infected granuloma due to pin slipping-out. The follow-up period was 6.7 months in average. The preliminary result was gratifying. According to the authors' experience, overhead skin traction has poor result with regard to facilitating reduction in patients aged from 17 months to 2 1/2 years. Skeletal traction is useful to the older children, but it may have adherent hazards of skin infection, physeal plate, damageand osteoporosis. By the use of soft tissue release and/or femoral shorting, the traction in the older children can be omitted, therefore the hospitalization will be greatly shortened. Acetabular reconstructive procedures using the hyaline cartilage as weight bearing surface should always be chosen whenever their indications and prerequisites are satisfied and the surgical techniques closed followed: Salvage operation Can be considered in older children with untreated CDH to improve head coverage and prepare a good bed for possible total hip replacement in the future. Limited experience and environmental factors might account for the high incidence of 14 complications in these 31 hips. Redislocation should be avoided by careful capsulorrþaphy and holding the hip in abduction during closure and cast application. Adequate pelvic redirection and avoidance of pin-slipping can alleviate the occurrence of postoperative subluxation. Ischemic necrosis probably related with the vascular insult due to the extreme position during preoperative traction, intraoperative injury, and postoperatire cast application. In the presence of joint stifness reoperation shoudn't be done. Fixation with either pin or plate should be secure to prevent slipping or angulation deformity If great care such as above mentioned is taken, theincidence of complication will be greatly avoided. Any complication should be detected as early as possible and treated properly in order to obtain a good final result. Long-term follow-up is essential for ultimate assessment and execution of appropriate treatment for possible residual deformity. Early diagnosis and better treatment of CDH, and avoidance of its complications during treatment are the most important factors intluencing the final results. |
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