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先天性髋关节脱位课件_2

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先天性髋关节脱位PPT 先天性髋关节脱位 先天性髋关节脱位课件 先天性髋关节脱 髋关节脱位PPT课件ppt 髋关节脱位PPT 性髋关节脱位
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*1 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 先天性髋关节脱位 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 绪论 ¨先天性髋关节脱位(CDH)又称为发育性 髋关节脱位(Developmental Dysplasia of the Hip, DDH)是一种对儿童健康影响较大的 病变,如能作到早期诊断和早期治疗临床 效果是满意的。, CDH是导致儿童肢体残 疾的主要疾病之一。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 流行病学调查 ¨先天性髋关节脱位其发生率世界各地区有较明显 差别,我国并没有完全整的统计资料,就上海某 些产院调查的约为0.91‰,北京地区为3.8‰,沈 阳某院为1.75‰,香港为0.07‰,这些资料都不够 全面,也不能反映我国的发生率,估计我国的发 生率大概为1‰。约20%的先髋脱位有家族史; 80%的先髋脱位是第一胎;沈阳某院新生儿普查 家族遗传为1/14,加拿大多伦多儿童医院226例中 只有4例有遗传史;遗传因素并非为先髋脱位发病 的重要因素。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨先髋脱位发病率以女孩占绝对优势,我国统计男 女之比为1:4.75. 地区与种族的发病率有很大差 别,这与遗传因素、环境影响和生活习惯有关; 习惯背婴儿的民族发生率低,如南非、中非一些 地区,爱斯基摩人,朝鲜族人和广东、香港地区 ;喜欢用捆绑方法的民族,使新生儿髋关节固定 于伸展、内收位,其发生率明显增高,如北意大 利,北美印地安人,德国和北斯堪地那维亚半岛 以及我国汉族的习惯。冬季出生的婴儿,其发生 率明显增高。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨臀位产发病率较高,国外约23%,上海26% ,沈阳28.5%,正常生产中只占5%;臀位产 发生先髋脱位较头位产高10倍;剖腹产发 生先髋脱位较阴道产高,上海统计占30%, 有显著差异,同时发现剖腹产中体重重的 婴儿发病率高。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 先天性髋关节脱位的主要病理特点 ¨①髂腰肌紧张、挛缩,压迫髋臼的入口; ¨②关节囊变形呈葫芦样; ¨③股骨头颈变形,主要有股骨头呈椭圆形 ,股骨颈短,股骨颈前倾角增大; ¨④髋臼变形,主要有髋臼窝浅小,呈三角 形,髋臼指数增大,关节盂唇内卷; ¨⑤股圆韧带增粗变长,关节软骨变性等。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 先髋脱位的分型: ¨1、单纯性先天性髋脱位 ¨(1)髋关节发育不良:又称为髋关节不稳定,X 线片常以髋臼指数增大为特点,多数采用髋关节 外展位而随之自愈,约1/10将来发展为先天性髋 脱位,还有少数病例持续存在髋臼发育不良,年 长后出现症状。 (2)髋关节半脱位:X线片有髋臼指数增大,髋 臼覆盖着部分股骨头,这是一种独立的类型,可 长期存在而不转化为全脱位。 (3)髋关节全脱位:股骨头完全脱出髋臼, Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 根据股骨头脱位的高低可分为四度 ¨Ⅰ度:股骨头仅向外方移位,位于髋臼同 一水平; ¨Ⅱ度:股骨头向外、上方移位,相当于髋 臼外上方水平; ¨Ⅲ脱出的股骨头位于髂骨翼的部位; ¨Ⅳ脱出的股骨头上移达骶髂关节水平。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2、畸形型先天性髋脱位 ¨典型者呈双髋脱位,双膝关节处于伸直位 僵硬,不能屈曲,两足平足呈外旋位,还 常合并上肢畸形 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 诊断 ¨一、 新生儿及婴儿先天性髋脱位 1、先天性髋脱位在新生儿期诊断较为困难 ,一旦确诊治疗容易,且会获得理想的治 疗效果。因为新生儿期病理改变最轻,易 于矫正;生后第一年骨盆发育最快,尤其 在新生儿期更快。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 2、临床症状 1.两侧大腿内侧皮肤皱褶不对称,患侧皮皱 加深增多。 2.患而会阴部增宽,双侧脱位时更为明显。 3.患者髋关节活动少,活动时受限。蹬踩力 量较健侧弱。常处于屈曲位,不能伸直。 4.患者肢体短缩。 5.牵拉患者下肢时有弹响声或弹响感,有时 患者会哭闹。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 3、体征 ¨患肢股动脉减弱或消失; ¨内收肌紧张痉挛; ¨Barlow试验阳性(仅适用于新生儿检查), 因髋关节不稳定随月龄的增加而减少,相 反外展受限随月龄的增加而增加。 ¨Ortolani征或外展试验阳性,此法可靠。 ¨Nelaton线征破坏。 ¨.套叠试验 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Ortolani试验 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Barlow ¨拇指加压,股骨头脱位 ¨解除拇指压力,股骨头自行复位 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨先天性髋关节 脱位的X线测量 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 髋臼指数测量法 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 4、X线检查 ¨髋臼指数 自Y形软骨中心至髋臼边缘作连 线,此线与Hilgenreiner线间夹角称髋臼指 数,此角说明髋臼之斜度亦是髋臼发育程 度 ¨骨盆平片:髋臼指数 正常为20-25°,至12 岁时基本恒定于15°,异常为30°; ¨Perkin‘s方格 正常位于内下象限 ¨Shenton氏线 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨YY′=Y线Hilgenreiner线;EP、E′P′=Perkin线 ;虚线=Shenton线(健侧相连续) ¨先天性髋关节 脱位的X线测量 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 治疗措施 ¨ 对先天性髋关节脱位的治疗应强强早期 诊断,婴儿期的治疗效果最佳,年龄越大 效果越差,一般认为2~3岁后治疗,即使 非常成功。于35岁以后,都将发生髋关节 痛,因此大多数学者强调要对新生儿进行 普查,以便早期诊断与治疗是获得痊愈的 重要措施。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 治疗方法 ¨有闭合复位+支架,闭合复位+蛙式石膏; 闭合复位+旋转截骨纠正前倾角;切开复位 ,并根据不同情况附加髋臼再造和各种截 骨术。具体治疗原则如下 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨(一)出生至2个月 不需牵引和麻醉,可 用屈曲双髋至90°而后逐步外展,将拇指置 于大粗隆外向前内方推压即可使其复位, 复位时切忌暴力,如复位成功后可用支架 固定于髋关节屈曲90°,外展70°,固定时间 约为2~3月,视复位时的年龄而定。支架 应于摄片检查后再定拆除时间。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 新生儿及婴儿期先天性髋脱位的治疗 ¨a、尿布枕 ¨b、连衣挽具 ¨c、Pavlik harness ¨d、Von-Rosen铝制夹板 ¨e、持续牵引复位 ¨f、内收肌切断闭合复位石膏固定+支架 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨3个月以上,2~3岁以下 这组病例因脱位时间长 ,髋周的软组织有不同程度的挛缩,因而在复位 之前,先作牵引,一般不超过2周,如有肌肉挛缩 比较明显者,必须在复位前作松解,如内收肌切 断,髂腰肌延长等,而后经床旁X线片证实,股 骨头的位置已与髋臼水平时,在全麻下用手术复 位,如复位后,位置满意,则应用蛙式石膏固定 。为了适应小儿生长发育需要,每2~3月更换石 膏1次,每次均需要X线片以证实股骨头在髋臼内 的位置。如发现更换石膏后又脱位者,必须再行 复位。每次更换石膏使大腿逐步内收,直到髋臼 发育正常后,才能拆除石膏固定。如果复位失败 ,则应考虑髋臼内有脂肪纤维组织增生,圆韧带 肥厚,哑铃状关节囊等情况存在,阻碍股骨头进 入髋臼,因而需作切开复位。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨(三)3岁以上至8岁 该组病儿脱位时间长 ,软组织挛缩更为明显,髋臼发育更差, 往往小而浅,而且臼底有大量脂肪纤维组 织存在,手法复位极为困难,因而绝大多 数需作切开复位。但在切开复位前必须做 牵引2~3周,直至股骨头牵引到髋臼平面 才能行手术治疗,如不能牵到髋臼平面, 则说明软组织挛缩明显,如果这时作切开 复位,股骨头缺血性坏死的可能性很大, 因而必须先作软组织松解,再作牵引。切 开复位后,根据不同情况附加旋行其它手 术有 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. 保守治疗的固定姿势:主张采用人位固定 (Human Position)而不用Lorenz体系的蛙 式位,其理由如下: 蛙式位是股骨头遭受髋臼压力最大的体位 ,尤其是对6个月以内的婴儿; 蛙式位时经过内收长肌与髂腰肌之间的旋 股内侧动脉遭受压迫,将直接影响股骨头 的血运; 蛙式位时,增大的盂唇可以压迫骺间沟, 致使股骨头发育受到影响,甚至产生畸形 。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨3、影响复位的因素 髂腰肌的挛缩; 盂唇过大,阻塞了髋臼而影响股骨头的复 位; 头、臼不称,通常是髋臼过小过浅; 其它:如髋臼内脂肪过多,圆韧带过长、 增宽在臼内形成阻塞,关节囊的挛缩等。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨4、复位后髋关节发育的观察 保持头、臼同心是髋关节发育的基本条件 ; 保守治疗一般头三个月用石膏固定,以后 改用支架固定,保持髋关节的有限制动; 固定时间一般为就诊月龄时间或加3个月, 一般每三个月复查一次并复查骨盆平片进 行监测; *28 单击此处编辑母版标题样式 单击此处编辑母版副标题样式 手术治疗 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Salter骨盆截骨术 ¨1、手术适应症:年龄在1.5-6岁的先天性髋关节脱位患儿,髋 臼指数在45°以下,股骨头大小与髋臼基本适应者。 2、手术前准备:必须进行牵引,可行皮牵引或骨牵引,牵引时 间不应少于3-4周,必须使股骨头达到髋臼Y形软骨线水平。 3、手术方法: 4、术中注意事项: 手术时对内收肌和髂腰肌均应切断,在关节囊外分离髂腰肌至股 骨小转子处应注意保护股神经;髋臼内的脂肪组织和圆韧带均应 清除,特别注意要切断髋臼横韧带;作髂骨截骨时应用线锯锯断 而不应用骨刀,理想的截骨应是在髂骨上、下棘之间,保持内低 外高,后低前高;髂骨远端应以耻骨联合为轴心,向前、下、外 方向牵引旋转,改变髋臼的方向;注意保持不能造成髂骨截骨后 方张开,这样达不到髂骨充分旋转。 5、术后治疗: 术后远用抗生素5-7天; 术后12-14天折线; 6-8周折石膏并可拔出固定钢针; 三个月后开始下地行走。 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. Pemberton髋臼成形术 ¨1、手术适应征: 年龄在2岁以上,髋臼发育不良,髋臼角大于45°以上, 头臼比例不适合髋臼不能包容股骨头者;手法或手术复 位后,经一定时间观察,髋臼仍发育不佳或未发育,股 骨头仍处于半脱位或全脱位;年龄超过7岁以上,耻骨 联合软骨已愈合,虽髋臼指数未超过45°者也适应此术 式。 2、术前准备:同Salter骨盆截骨术。 3、手术步骤: 4、术后治疗: 外展内旋位单髋人字石膏固定; 术后14天折线,术后6-8周折石膏; 术后3-6个月下地行走 Through this publicity campaign, further improve the sense of business integrity of tourism enterprises to help tourism consumers and operators to safeguard the legitimate rights and interests, to ensure that our City's tourism sustainable, healthy and coordinated Development. ¨先髋脱位的手术方法很多,超过100余种,但其基 本原理均相同。目前公认的经典根治性手术是 Salter骨盆截骨术和Pemberton髋臼成形术。其它手 术均属于补救性的或者称为姑息性手术,适用于 年龄超过8-10岁以上的儿童,主要目的在于改善 其负重功能。相比之下,Stahali髋臼盖成形术和 Steell三相髂骨截骨术效果较好,但后手术操作过 于复杂,手术打击也过大。 Zahradnick手术由于 术后其关节功能太差,不宜提倡,由于其手术成 功率是很高,可作为多次手术失败病例的选择
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