1、了解一下了解一下DDH吧！吧！WHY？10个月个月11岁岁40岁岁4个月个月 可复性的脱位DDH Management Overviewl 0-6 months Pavlik harnessl 6 Months 2 years,failed Pavlik Closed reduction tenotomies,hip spica cast 3 monthsl 2-3 years,failed closed reduction Open reductionl 3+years Open reduction femoral osteotomy pelvic osteotomyFour general
2、 types of osteotomiesl Single innominate(Salter)l Acetabuloplasty(Pemberton)l Triple innominate(Steel)l Shelf(Chiari)SalterSalter Single Innominatel Age 18 months 6 yearslRequires concentrically reduced hiplOpen reduction at same time possiblelIliopsoas and adductor tenotomies often requiredlCovers
3、antero-lateral acetabular deficiencyl Up to 15of acetabular index correctedAlbee AcetabuloplastyPemberton Acetabuloplastyl Requires reduced hipl Decreases acetabular volume(small head)l Remodeling of acetabulum required Corrects 15AIl Reduces antero-lateral acetabular defectsl Cuts altered to cover
4、more anteriorly or laterallySteel Triple Innominate OsteotomySteel Triple Innominate Osteotomyl Age Skeletally maturel Requires congruent hip jointl Divides ilium,ischium and superior ramusl Acetabulum rotationally freel Indicated when other osteotomies not possiblel Rotates to cover any acetabular defectChiari Medial DisplacementlAge skeletally maturelSalvage operation onlyl Used when no other osteotomy possiblel Possible with subluxed hiplCovers well laterallyl Anterior and posterior augmentation may necessarylMay be useful in other conditionsl Coxa magna,OA in dysplasic hips
