改良莎氏术治疗先天性髋脱位疗效观察及并发症的预防
Effect survey and complications prevent of congenital hip dislocation cured by improved Zahradnicek operation
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摘要: 目的: 观察改良莎氏术治疗先天性髋脱位的疗效及并发症的原因和预防措施。方法: 自1992~2002年共行改良莎氏手术196例262髋。选择合适的髋臼锉扩大髋臼,加深至Y软骨。加深髋臼时,在尽可能保留软骨面的前提下向内、上后方加深,使髋臼能覆盖2/3股骨头即可。直视下测定股骨颈前倾角及股骨颈干角。据不同的畸形做相应的股骨粗隆下截骨,截骨1.5~3.0 cm,用115°钢板固定。保持前倾角5°~10°,颈干角115°。结果: 随访66例96髋,优53.1%,良30.2%,可10.4%,差6.3%,优良率83.3%。并发症:髋关节活动受限14髋,脱位或半脱位12髋,股骨头无菌性坏死9髋,截骨处骨不连接1髋。结论: 改良莎氏手术治疗先天性髋脱位疗效确切,但该术式相应发生的并发症也应引起重视。Abstract: Objective: To evaluate the efficiency of improved Zahradnicek operation in treatment of congenital hip dislocation and measures to prevent the complications.Methods: Two hundred and sixty two cases of congenital hip dislocation(196 patients) from 1992 to 2002 underwent improved Zahradnicek operation.The acetabulum was expanded and deepened to Y cartilage with a suitable drill;meanwhile the surface of cartilage was reserved as far as possible so that the acetabulum could cover 2/3 of the femur head.Under direct observation of the anteversive angle and cervical shaft angle,the femur osteotomy of corresponding subtuberosity of cuboid bone was performed according to different deformities.The femur was cut down about the length of 1.5-3.0 cm and fixed with 115° angle curved steel.Anteversive angle 5°-10° and cervical shaft angle 115° were retained.Results: Ninety-six hip joints of 66 patients were available at final follow-up.The results were excellent in 53.1%,good in 30.2%,fair in 10.4% and poor in 6.3%.The excellent and good rates were 83.3%.There were confined activity of hip joints in 14 cases;hip joint dislocation or semidislocation in 12 cases;femural head sterile necrosis in 9 and nonunion in 1.Conclusions: This method can completely or nearly restore the hip joint to normal anatomic and functional position,but its complications should also be attached importance to. Back