DDH早期干预与早期治疗

DDH早期干预与早期治疗DDH, Early Intervention & Treatment,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,2,DDH早期干预与治疗,单纯髋臼发育不良 股骨头外移轻微,病变恶化 假髋臼开始形成 股骨头形态改变,站立,1,2,3,体重股骨头加速外移髋臼外缘发育受阻,严重程度,年龄 AGE,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,3,DDH早期干预与治疗,早期诊断DDH具有非常重要的治疗意义,早期诊断为早期干预性治疗创造条件和机会,早期干预和治疗效果好,早期治疗费用低,早期治疗可直接降低儿童期发病率，改善我国儿童健康素质,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,4,DDH早期干预与治疗,Rosenberg等认为：临床上髋关节不稳定是DDH的早期症状，若不在幼儿时进行治疗，可以发展成为髋关节的退行性变化或关节的脱位而引起成年生活的功能障碍,更多的学者指出，在绝大多数病例，出生几个月内的早期诊断可以使DDH的保守治疗获得成功,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,5,DDH早期干预与治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,6,DDH早期干预与治疗,早期治疗,早期干预,早期诊断,早期干预与早期治疗,通过有组织的随访观察髋关节的发育采用自我运动或软器械促进髋关节发展,出生3个月内完成诊断,行走前完成治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,7,DDH早期干预与治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,8,DDH早期干预与治疗,早期干预和治疗的原则是尽可能保持股骨头与髋臼的同心对位，并通过适度的活动刺激促进其正常发育股骨头与髋臼的同心对位是刺激髋关节正常生长的前提和基础,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,9,DDH早期干预与治疗,Pavlik吊带,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,10,DDH早期干预与治疗,Pavlic吊带可以干预髋关节发育不良，也可以治疗髋关节脱位作为一种软性治疗， Pavlic吊带在世界各地获得了广泛的普及和应用，是DDH干预和治疗手段中使用最为广泛的方法,近年来，Pavlic吊带辅助超声波髋关节检查监测治疗，形成个性化治疗模式,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,11,DDH早期干预与治疗,软支架,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,12,DDH早期干预与治疗,可调节蛙式支架,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,13,DDH早期干预与治疗,支架治疗适用于6- 9个月DDH患儿完全脱位患儿要行双侧内收长肌松解半脱位患儿视内收长肌紧张程度情况决定是否患侧松解。支架固定期为3 -6月,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,14,DDH早期干预与治疗,手法复位+蛙式石膏固定,适用于6个月以上，X线摄片股骨头骨化中心开始显露的病例超过12个月或是脱位关节非常紧张的病例可以考虑复位前的牵引,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,15,DDH早期干预与治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,16,DDH早期干预与治疗,安全角,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,17,DDH早期干预与治疗,蛙式石膏的固定期一般固定期为3个月期间每隔4或6周复查X线摄片,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,18,DDH早期干预与治疗,后期处理可调节式支架佩戴第一格维持2月以后每一格1.5月调整一格一般使用5-7月,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,19,DDH早期干预与治疗,晚期病例,晚期初发病例 年龄大于18个月的初诊病例,晚期残余病例 经保守治疗失败病例,残余病例,18月,晚期病例,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,20,DDH早期干预与治疗,手术治疗,年龄18月，AI25度,手术治疗上限,双侧脱位6岁，单侧脱位8岁，发育不良年龄不限,保守治疗,年龄6月，骨盆平片,手术方式,Salter骨盆截骨股骨近端内翻、短缩、旋转截骨Pemberten髋臼成型股骨近端内翻、短缩、旋转截骨,DDH临床治疗指南,中华小儿外科学会骨科学组 2009,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,21,Pavlik吊带用于早期治疗的有效率为82.46Effective rate from ET using Pavlik harness is 82.46%,无股骨头缺血性坏死No AVN occur during this group,7例，10髋，X线摄片髋臼指数257 cases, 10 hips, AI above 25,DDH早期干预与治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,22,3例，4髋，随访至18月，囊外Salter截骨术3 cases, 4 hips, follow-up to eighteen months, finally Salter Osteotomy preformed without capsule opening.,手术率5.26Surgical rate for residual DDH is 5.26,DDH早期干预与治疗,2017/12/3,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Ji