两例病例及文献综述报告:儿童外伤性髋关节脱位治疗后再脱位

骨科医师之家  2017年8月15日  阅读数:1229  字体:    

Redislocation after treatment of traumatic dislocation of hip in children: a report of two cases and literature review

两例病例及文献综述报告:儿童外伤性髋关节脱位治疗后再脱位

Abstract

   From August 1998 to June 2005, we treated five children (age range 2–9 years) with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range 1–8 years). There was acceptable reduction in all cases by single attempt at closed reduction. Two patients aged 2 and 3 years, respectively, had redislocation. Other complications like nerve injuries, avascular necrosis, growth disturbance, ectopic ossification and post-traumatic arthritis were not seen till the last follow-up (mean 4.1; range 1–8 years). Closed reduction is an effective treatment method for traumatic dislocation of hip in children, but adequate immobilization and protection from weight bearing is needed in children aged less than 10 years to prevent redislocation.

摘要

    从1998年8月到2005年6月,我们治愈了五例儿童外伤性髋关节脱位(年龄范围为2 - 9岁)。平均随访时间为4.1年(范围1 - 8年)。这些病例仅用一次闭合复位就能达到理想的复位效果。但有两名患者(分别为两岁和三岁)在治疗后出现了再脱位,但直到最后一次随访(平均4.1年,范围1 - 8年),也没有出现其他如神经损伤、股骨头缺血性坏死、生长障碍、异位骨化和创伤性关节炎等并发症。对于儿童外伤性髋关节脱位,闭合复位是一种有效的治疗方法,但未满十岁的儿童还需要加强固定并防止负重,防止再脱位。

Case series report

From August 1998 to June 2005, five children were treated for traumatic dislocation of hip at our hospital. The male:female ratio was 2:3. Their mean age was 4.6 years (range 2 - 9 years). The average follow-up period was 4.1 years (range 1 - 8 years). The diagnosis of traumatic dislocation of hip was made by injury mechanism and radiological examination. Three children had mild injury from simple fall and two patients had road traffic accident. Three children had dislocation of the right hip and two had left hip. All five children had posterior dislocation. One patient (aged 9 years) had ipsilateral acetabular (Thompson Epstein type 1) and contralateral tibial shaft fracture (Gustillo Anderson type 2). Reduction was performed within 2 h after injury in four cases. One case visited our hospital late after failed attempts of closed reduction at a local hospital (Fig. 1a). Closed reduction was successfully performed at our hospital under general anesthesia 8 h after the injury.

病例报告

   本院自1998年8月到2005年6月共收治五例儿童髋关节外伤性脱位。男女比例为2:3。平均年龄为4.6岁(范围2 - 9年)。平均随访期为4.1年(范围1 - 8年)。髋关节外伤性脱位由损伤机制和放射检查诊断得出。三例患者仅由摔落造成轻度损伤,另两例患者则发生道路交通事故。三例患者右髋骨脱位,另两例左髋骨脱位。五例患者都是向后脱位。一位患者(9岁)同侧髋臼骨折(1型 Thompson Epstein)并对侧胫骨干骨折(2 型 Gustillo Anderson)。四例患者受伤后两小时内即实施了复位。一例患者在当地医院实施闭合复位手术失败后转入我院治疗(图1.a)。该患者受伤8小时后,在我院全身麻醉下成功实施闭合复位术。

In three cases, closed reduction was performed under intravenous sedation. In the case associated with acetabular and tibial fracture, after reduction of the hip, spica cast was applied, and the tibial fracture was treated by external fixation under general anesthesia. Two patients, both aged less than 3 and 2 years, respectively, were kept on skin traction for 10 and 14 days, respectively (parents’ acceptance of hip spica cast was poor), followed by early ambulation. For the remaining three patients, after closed reduction, hip spica cast was applied for 6 weeks and, weight-bearing walking was allowed after removal of spica cast.

三例病例在静脉麻醉下实施闭合复位术。对于髋臼及胫骨骨折相关病例,髋骨复位后需用人位石膏固定,而胫骨骨折需在全身麻醉下使用外部固定。两例患者(年龄小于3岁和2岁),分别进行10天和14天皮肤牵引(父母对髋骨人位石膏的接受度低),然后给予早期下床活动护理。剩下三例患者实施闭合复位术后,使用髋骨人位石膏固定6周,石膏移除后允其负重行走。




Fig. 1 All images belong to the same patient. a Initial radiograph in 3-year-old girl demonstrating

incomplete reduction of right hip joint. b Five months after reduction, redislocation developed after a simple fall. c X ray in hip spica cast after re-reduction showing satsifactory joint reduction. d One year follow-up radiograph after re-reduction demonstrates normal appearence of right hip joint. e Post-reduction magnetic resonance image after first dislocation, demonstrating associated severe soft tissue injury. f Post-reduction magnetic resonance image after redislocation, demonstrating injury of the right hip joint capsule.

图1 图片来自同一患者。a:3岁女孩的初始放射照片,显示右髋骨关节不完全复位。b:复位五个月后仅由摔落导致再脱位。c:再次复位后髋骨人位石膏X光照射,显示关节复位良好。d:再次复位后一年随访期x光照射,显示右髋骨关节正常。e:首次脱位后复位磁共振图像,显示软组织相关损伤严重。f:再脱位后复位磁共振图像,显示右髋关节囊损伤。


Results

There was acceptable reduction for all cases by closed reduction. None of the cases had pain, limping, nerve injuries, instability and limb length discrepancy. During follow-up (1 - 8 years) avascular necrosis, premature epiphyseal closure, traumatic osteoarthritis, ectopic ossification was not observed in any of the cases.

结果
     所有病例实施闭合复位术后效果良好,且都未出现疼痛、跛行、神经损伤、不稳定和肢体长短不一的情况。随访期间(1 - 8年)所有病例均未观察到股骨头缺血性坏死、骨骺过早闭合、创伤性骨关节炎、异位骨化等症状。

Two patients had redislocation during the follow-up period due to minor trauma by simple fall at 5 and 7 months, respectively, after primary dislocation (Fig. 1b).The children were aged 3 and 2 years and had early weight-bearing walking after 10 and 14 days of skin traction, respectively. Both cases of redislocation were treated with hip spica cast for 6 weeks, after successful closed re-reduction (Fig. 1c). At the final follow-up, the hips were stable and no further redislocation was detected (Fig. 1d).

两例患者分别在首次脱位5个月和7个月的随访期间出现再脱位(图1b),由于摔落造成轻度损伤。两例患者(分别为三岁和两岁)分别接受皮肤牵引10天和14天,并使其早期负重行走。两例再脱位患者成功进行再次封闭复位,并接受人位石膏固定治疗6周。最后随访中,髋关节稳定,未检测到进一步再脱位现象(图1d)。

 

Conclusion

In the treatment of traumatic dislocation of the hip in children, adequate immobilization and protection from weight bearing is required to prevent redislocation in younger children under the 10 years. With the cooperation of their guardians’ regular yearly long-term follow-up to monitor the early development of complications such as avascular necrosis, growth disturbance, traumatic arthritis and ectopic ossification should be encouraged.

结论

治疗儿童外伤性髋关节脱位时,未满10岁的年幼儿童需要加强固定并防止负重,防止再脱位。鼓励其监护人长期配合,每年进行固定随访,监测股骨头缺血性坏死、生长障碍、创伤性关节炎和异位骨化等并发症的早期发展。

 




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