DDH早期干預(yù)與早期治療教程文件

1、DDH早期干預(yù)與早期治療2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University2q 單純髖單純髖臼臼發(fā)發(fā)育不良育不良q 股骨股骨頭頭外移外移輕輕微微q 病變惡化病變惡化q 假髖臼開始形成假髖臼開始形成q 股骨頭形態(tài)改變股骨頭形態(tài)改變站站立立1 12 23 3體重股骨頭加速外移髖臼外緣發(fā)育受阻嚴(yán)重程度嚴(yán)重程度年齡年齡 AGE2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong Universit

2、y62022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University72022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University8早期干預(yù)和治療的原則是盡可能保持股骨頭與髖臼的同心對位，并通過適度的活動刺激促進(jìn)其正常發(fā)育股骨頭與髖臼的同心對位是刺激髖關(guān)節(jié)正常生長的前提和基礎(chǔ)2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Sha

3、nghai Jiaotong University9Pavlik吊帶2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University10 Pavlic吊帶可以干預(yù)髖關(guān)節(jié)發(fā)育不良，也可以治療髖關(guān)節(jié)脫位作為一種軟性治療， Pavlic吊帶在世界各地獲得了廣泛的普及和應(yīng)用，是DDH干預(yù)和治療手段中使用最為廣泛的方法 近年來，Pavlic吊帶輔助超聲波髖關(guān)節(jié)檢查監(jiān)測治療，形成個性化治療模式2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Sh

4、anghai Jiaotong University11軟支架2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University12可調(diào)節(jié)蛙式支架2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University13支架治療適用于6- 9個月DDH患兒完全脫位患兒要行雙側(cè)內(nèi)收長肌松解半脫位患兒視內(nèi)收長肌緊張程度情況決定是否患側(cè)松解。支架固定期為3 -6月2022-5-18CHEN BOCHANG

5、MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University14手法復(fù)位手法復(fù)位+ +蛙式石膏固定蛙式石膏固定適用于6個月以上，X線攝片股骨頭骨化中心開始顯露的病例超過12個月或是脫位關(guān)節(jié)非常緊張的病例可以考慮復(fù)位前的牽引2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University152022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong

6、University16安全角2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University17蛙式石膏的固定期2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University18后期處理可調(diào)節(jié)式支架佩戴第一格維持2月以后每一格1.5月調(diào)整一格一般使用5-7月2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jia

7、otong University19晚期病例晚期初發(fā)病例 年齡大于18個月的初診病例晚期殘余病例 經(jīng)保守治療失敗病例殘余病例18月,晚期病例2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University20手術(shù)治療手術(shù)治療年齡18月，AI25度手術(shù)治療上限手術(shù)治療上限雙側(cè)脫位6歲，單側(cè)脫位8歲，發(fā)育不良年齡不限保守治療保守治療年齡6月，骨盆平片手術(shù)方式手術(shù)方式Salter骨盆截骨股骨近端內(nèi)翻、短縮、旋轉(zhuǎn)截骨Pemberten髖臼成型股骨近端內(nèi)翻、短縮、旋轉(zhuǎn)截骨DDH臨床治療指南中華小兒外科學(xué)

8、會骨科學(xué)組中華小兒外科學(xué)會骨科學(xué)組 20092022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University21Pavlik吊帶用于早期治療的有效率為82.46Effective rate from ET using Pavlik harness is 82.46%無股骨頭缺血性壞死No AVN occur during this group7例，10髖，X線攝片髖臼指數(shù)257 cases, 10 hips, AI above 25 2022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University223例，4髖，隨訪至18月，囊外Salter截骨術(shù)3 cases, 4 hips, follow-up to eighteen months, finally Salter Osteotomy preformed without capsule opening.手術(shù)率5.26Surgical rate for residual DDH is 5.262022-5-18CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jia