Surgical Hip Dislocation is Safe and Effective Following Acute Traumatic Hip Instability in the Adolescent
Surgical Hip Dislocation is Safe and Effective Following Acute Traumatic Hip Instability in the Adolescent
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青少年急性创伤性髋关节不稳定后，髋关节脱位手术是安全有效的
DOI：
10.1097/bpo.0000000000000316
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发表时间：
2015
影响因子：
1.7
通讯作者：
D. Sucato
中科院分区：
文献类型：
--
作者：
D. Podeszwa;A. Rocha;A. Larson;D. Sucato
背景：小儿外伤性髋关节脱位是一种罕见但潜在的灾难性损伤。本研究的目的是回顾我们对儿童和青少年患者创伤性不稳定引起的关节内髋关节病理采用手术髋关节脱位（SHD）方法治疗的早期临床结果和髋关节放射学形态学。方法：对外伤性髋关节不稳定后出现非同心复位的连续患者进行回顾性分析。所有患者均接受经粗隆SHD治疗，并根据关节内检查结果进行相关手术。在最后随访时完成影像学评估和Harris髋关节评分。结果：男性11例，平均年龄12.3岁（范围9.3 ~ 16.1 y），平均体重指数19.6 kg/m2（范围15.4 ~ 28.0 kg/m2）。术中表现包括：唇部撕裂（8例），股骨软骨损伤（5例），髋臼缘骨折（4例），髋臼软骨剥离（3例），体松脱（2例），股骨头骨软骨骨折（1例）。术后1例出现一过性腓神经麻痹。术后平均24.5个月（12.0 ~ 48.1个月），无髋部出现骨坏死的影像学证据。平均外侧中心边缘角度为20度（范围9 ~ 38度），6髋<20度；平均髋臼指数9度（范围：- 2 ~ 23度），髋部5髋，髋部为- 10度；意味着agr;-角度56度（范围48至62度），6个髋部为55度；平均髋臼12度（范围8 - 16度），髋部8个<15度。在1年的随访中，Harris髋关节平均评分为95.8（范围为84.7 - 100）。结论：早期结果表明，SHD是一种安全的治疗髋后不稳定后不完全复位的方法，对识别和治疗急性关节内病理是有效的。髋臼发育不良、髋臼相对后移和/或股骨偏移减小可能是青少年髋后不稳定的危险因素。证据等级：四级。
Background: A traumatic hip dislocation in the pediatric patient is a rare but potentially catastrophic injury. The purpose of this study was to review our early clinical results and radiographic morphology of hips treated with a surgical hip dislocation (SHD) approach for intra-articular hip pathology resulting from traumatic instability in pediatric and adolescent patients. Methods: This is a retrospective analysis of a consecutive series of patients presenting with nonconcentric reduction after traumatic hip instability. All patients were treated with a transtrochanteric SHD with concomitant procedures based on intra-articular findings. Radiographic evaluations and Harris Hip Scores were completed at final follow-up. Results: Eleven male patients, mean age of 12.3 years (range, 9.3 to 16.1 y) and mean body mass index 19.6 kg/m2 (range, 15.4 to 28.0 kg/m2). Intraoperative findings included: labral tear (8), femoral cartilage injury (5), acetabular rim fracture (4), acetabular cartilage delamination (3), loose body (2), and femoral head osteochondral fracture (1). Postoperatively, 1 patient developed a transient peroneal nerve palsy. At a mean 24.5 months (range, 12.0 to 48.1 mo) postoperatively, no hips have radiographic evidence of osteonecrosis. The mean lateral center edge angle was 20 degrees (range, 9 to 38 degrees) with 6 hips of <20 degrees; mean acetabular index 9 degrees (range, −2 to 23 degrees) with 5 hips of >10 degrees; mean &agr;-angle 56 degrees (range, 48 to 62 degrees) with 6 hips of >55 degrees; mean acetabular version 12 degrees (range, 8 to 16 degrees) with 8 hips of <15 degrees. At 1-year follow-up, the mean Harris Hip Score was 95.8 (range, 84.7 to 100). Conclusions: Early results suggest that SHD is a safe approach to treat an incomplete reduction following posterior hip instability and is effective for identification and treatment of acute intra-articular pathology. Acetabular dysplasia, relative acetabular retroversion, and/or decreased femoral offset may be risk factors for posterior hip instability in adolescents. Level of Evidence: Level IV.