DDH早期干预与早期治疗剖析课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,DDH,早期干预与早期治疗,DDH,Early Intervention&Treatment,DDH早期干预与早期治疗DDH,Early Interv,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,5,DDH,早期干预与治疗,早期宣教,早期诊断,早期随访,新生儿医生、儿童保健医生,Early Intervention and Treatment,早期干预,DDH,晚期治疗,功能康复,早期治疗,儿童骨科医生、骨科医生、康复专业,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,7,DDH,早期干预与治疗,年龄,方法,新生儿,6,个月,外展操、宽尿布等,新生儿,6,个月,Pavlik,吊带,6,9,个月,各类外展支具,6,18,个月,手法复位蛙式石膏,12,18,个月,牵引后手法复位,+,蛙式石膏,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,9,DDH,早期干预与治疗,Pavlik,吊带,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,11,DDH,早期干预与治疗,软支架,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,15,DDH,早期干预与治疗,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,16,DDH,早期干预与治疗,安全角,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2023/9/20CHEN BOCHANG MD,2024/11/14,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,2009,2023/9/20CHEN BOCHANG MD,2024/11/14,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,82.46,Effective 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,25,7 cases,10 hips,AI above 25,DDH,早期干预与治疗,2023/9/20CHEN BOCHANG MD,2024/11/14,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,5.26,Surgical rate for residual DDH is 5.26,DDH,早期干预与治疗,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,23,DDH,早期干预与治疗,17,月,3,岁,11,岁,Pemberten,Femoral Osteotomy,Salter,Femoral Osteotomy,Triple Pelvic Osteotomy,Femoral Osteotomy,手术治疗仍是当前国内,DDH,晚期和残余病例治疗的主要手段,2023/9/20CHEN BOCHANG MD,2024/11/14,CHEN BOCHANG MD Shanghai 6th Peoples Hospital Shanghai Jiaotong University,24,DDH,早期干预与治疗,Thanks for Your Attention,2023/9/20CHEN BOCHANG MD,