Treatment of congenital hip dislocation

The principle of treatment for this disease is early diagnosis and timely treatment. Once the diagnosis of congenital hip dislocation is established after birth, the treatment should be started immediately, and it can be expected to obtain a hip joint with nearly normal function. The older the age at the start of treatment, the worse the results.

1. Conservative treatment

The theoretical basis for conservative treatment is Harris' law, which states that concentricity of the head and socket is essential for the development of the hip joint. In order to realize the stability of the hip joint after reset, the following conditions must be available: ① Choose a posture to maintain the stability of the hip joint, the traditional frog position is the most ideal posture, but it is not conducive to the blood supply of the femoral head. ② Choose a brace, splint or plaster fixation according to the different ages of the patients, which is required to be stable, comfortable, convenient, easy for urinary and fecal management, and preferably to keep the hip joint in proper motion. ③Choose the most suitable age for hip joint development, the younger the better, usually under 3 years old. ④ The proportion of head and socket should be proportional, if the proportion is disproportionate, the stability of the hip joint can not be maintained, and even the treatment fails. ⑤ The reset should be maintained for a certain period of time, so that the joint capsule retracts to near normal and can no longer be dislocated after removing the fixation. Usually it takes 3 to 6 months, the younger the patient, the shorter the fixation time accordingly.

2. Surgical treatment

(1) Salter pelvic osteotomySalter surgery, in addition to resetting the femoral head, is mainly to make the abnormal acetabular direction into the normal physiological direction, relatively increase the depth of the acetabulum, so that the femoral head and acetabulum to achieve concentric. Hip dislocations between the ages of 1 and 6 years old, including those who have failed manipulative reset, can be treated with this technique.

(2) Pemberton acetabuloplasty is performed by osteotomizing the acetabulum 1-1.5 cm above the superior rim of the acetabulum parallel to the slope of the acetabular apex, prying up the acetabular end downward and changing the inclination of the acetabular apex, so as to make the acetabulum fully encompass the head of the femur, and make the acetabulum reach a normal shape. This procedure can be used if the age is more than 7 years old, or if the acetabular index is more than 46° under 6 years old.

(3) Femoral rotational osteotomy and femoral shortening osteotomy Femoral rotational osteotomy is suitable for those with anterior tilt angle of 45°～60° or more, and should be performed at the same time with the above surgery. Generally, the femur is cut under the small rotor, usually with wire saw, and the proximal end of the femur is internally rotated or the distal end of the femur is externally rotated after the osteotomy, and then fixed with a 4-hole plate, but it should be noted that the correction should not be excessive. Femoral shortening osteotomy is suitable for older age, Ⅲ degree dislocation, especially the preoperative traction is not in place, also in the small rotor osteotomy, shortening about 2 cm, can also be corrected at the same time the anterior tilt is too large, and then also fixed with a 4-hole steel plate.