Congenital dislocation of the hip also known as developmental hip dislocation or developmental dysplasia of the hip (DDH) is a more common congenital malformation. Epidemiology The incidence of this disease is affected by many factors, such as geographic area, living habits, ethnicity, etc., and its incidence is very relevant, the incidence is higher in northern Italy, France and southern Germany, Mckeown et al. 1960 reported that the incidence rate in Birmingham, England was 0.7%, and Sweden was 1%, and the incidence rate is also higher in Japan and Amerindian tribes. And Hodgson that the incidence of our China is very low, he mainly refers to the southern region of China, because of the habit of bringing children is two hip separation; knee flexion, because this baby position can correct the hip dislocation, and in fact, in different parts of our country the incidence rate is not consistent, but the lack of complete statistical data. But the incidence rate is not too low. And in the African region, the incidence rate is the lowest region in the world. Our data is roughly: the incidence rate of surviving children is 1%. The left side is more than the right side is about 10:1, bilateral dislocation to the right side is more serious. The incidence of congenital hip dislocation is higher in first-born babies, especially in breech babies, and about 16% of breech babies suffer from congenital hip dislocation. Different regions have different incidence rates, the incidence rate in northern China is higher than that in the south, the incidence rate in northern China is 3.8%, in eastern China is 1.1%, and in southern China is 0.7%. Etiology The etiology of congenital hip dislocation has not been completely clarified so far. Of course, multiple deformities attached to the hip dislocation should belong to the congenital deformity. In general, in recent years, most scholars believe that the etiology is not a single. This means that there are many factors to participate in order to cause this disease. (A) genetic factors undeniable fact that this disease has a clear family history, especially in twin babies more obvious, the incidence of this disease in the patient’s family can be as high as 20 ~ 30%, and more common in sisters. The same disease can occur in sisters with three types of hip dislocation and dysplasia. If detailed, early examination and X-ray diagnosis are not carried out, except for the first type, the latter two types can often be missed and the hip joint has been completely normal by the time the patient reaches the age of 7 or 8 years. (B) Ligament laxity factor In recent years, more and more reports have proved that laxity of joint ligaments is an important factor. In animal experiments Smith will be puppy’s joint capsule, round ligament excision, produce hip dislocation phenomenon of high percentage, clinically Andren pointed out that the X-ray film in the pubic symphysis separation in hip dislocation cases for the normal infants twice, he thinks that this is the mother in the process of production needs a lot of endocrine ligament laxity, excessive endocrine changes is caused by hip dislocation is an important factor. Meanwhile, Andren, Borglin found changes in urinary estrone (Estrone) estradiol 17β (Estradil) excretion compared with normal infants in newborn hip dislocation cases within 3 days. However, Thieme utilized 16 sick infants compared to 19 normal infants and when measured month by month, statistically processed found no difference. Therefore, the theory that endocrine changes cause ligamentous laxity cannot yet be established. (C) Position and mechanical factors Hip dislocation cases of breech births have been reported as high as 16-30% of the cases, and breech births account for only 3% of normal births. Wikinson (1963) fixed young children’s hips in flexion, external rotation, and knee extension, and gave estrogen and progesterone. Hip dislocation deformity can occur. Postnatal position has also been suggested as a factor in this condition. For example, the high incidence in Sweden and American Indians is due to the application of swaddling position in infants. Clinical manifestations (1) neonatal and infantile manifestations: ① Symptoms: A, joint mobility disorders: the affected limb is often flexed, the activity is poorer than the healthy side, the pedal force is weaker than the other side, the hip joint abduction is limited. B. Shortening of the affected limb: the femoral head of the affected side is dislocated backward and upward, and the corresponding shortening of the lower limb is common. C, skin lines and changes in the perineum: asymmetry of the skin folds on the buttocks and inner thighs, the skin lines on the affected side are deeper than those on the healthy side, the number increases, the labia majora of female infants are asymmetrical, and the perineum is widened. ② Examination: A. Ortolani test and Barlow test: for congenital hip dislocation between birth and 3 months of age. It was first proposed by Ortolani in 1935 and improved by Barlow.Ortolani’s method is to flex the child’s knees and hips to 90°, the examiner puts the thumb on the inner thigh of the child, and the forefinger and middle finger on the greater trochanter, and gradually abducts and externally rotates the thigh. If there is dislocation, you can feel the femoral head embedded in the acetabular rim, which produces a slight resistance to abduction, and then lift the greater trochanter with the middle finger of the index finger, the thumb can feel the femoral head sliding into the acetabulum when the popping, i.e., Ortolani’s test is positive. barlow test is the reverse of the operation of Ortolani’s test, the examiner, so that the patient’s thighs passive inwardly rotated and the thumb outwardly above the pressure on the femur rotor. A popping motion can be felt again. B. Allis’s sign (Galezzi’s sign): make the newborn lie down and bend the knee 85 ° ~ 90 ° legs together, the heels of the feet are aligned, such as this disease can be seen in the two knees are not equal. This is caused by upward displacement of the femur on the affected side. C. Sleeve test: make the child lying down, the affected side of the hip and knee joints are flexed 90 °, the examiner holds the distal femur and knee joint with one hand and presses the groin with the other hand, and if you feel that the greater trochanter is moving up and down when you are lifting and pushing the knee of the affected limb, it is positive for the sleeve test. D. Hip and knee flexion and abduction test: make the baby lying down, hip and knee flexion, the examiner holds the knee with both hands, thumb on the inside of the knee, the rest of the four fingers on the knee, the outside of the normal baby can generally abduct about 80 °, if only 50 ° ~ 60 ° abducted, it is positive, can only be abducted 40 ° ~ 50 ° for a strong positive. (2) Manifestations in early childhood: ① Symptoms: A. Limping gait: limping is often the only complaint of parents when pediatricians visit the clinic. One side of the dislocation manifested as claudication; bilateral dislocation is manifested as “duck step”, the child’s buttocks obviously protruded backward lumbar anterior convexity increased. B, the affected limb shortening deformity: in addition to shortening at the same time there is internal deformity. ② check: A, Nelaton line: anterior superior iliac spine and sciatic tuberosity line, normally through the apex of the greater trochanter, known as the Nelaton line, hip dislocation of the greater trochanter above this line. B. Trendelenburg test: the child is asked to stand on one leg, the other leg as much as possible to flex the hip, flexion of the knee so that the foot off the ground, the normal standing on the opposite side of the pelvis rises; hip dislocation of the femoral head can not hold the acetabulum, the gluteus medius muscle weakness, so that the opposite side of the pelvis falls. Observation from behind is especially clear, called Trende lenburg test positive, is a sign of hip joint instability. 2.Classification (1)Classification according to the relationship between the femoral head and acetabulum: Generally, it can be classified into the following three types: ①Congenital dysplasia: the femoral head is only slightly shifted outward, Shenton’s line is basically normal, but the angle of the CE can be reduced, and the acetabulum becomes shallow, which is referred to by Dunn as congenital hip dislocation grade I. ②Congenital subluxation: the head is only slightly shifted outward, and the line is basically normal. ② Congenital subluxation: the head of the femur is displaced outward and upward, but still forms a joint with the lateral part of the acetabulum, Shenton’s line is discontinuous, CE angle is less than 20°, and the acetabulum becomes shallow, which belongs to Dunn’s classification of grade II. (iii) Congenital complete dislocation: the femoral head is completely outside the true acetabulum, forming an articulation with the lateral aspect of the ilium, gradually forming a false acetabulum, and the original joint capsule is embedded between the femoral head and the ilium, which belongs to Dunn Classification Grade III. (2) Classification according to the degree of dislocation: Sun Zaikang refers to Zionts’ standard and classifies it into 4 degrees as follows: ①Ⅰ degree dislocation: the epiphyseal nucleus of the femoral head is located below the Y line, and outside of the vertical line of the outer upper edge of the acetabulum. ② Ⅱ degree dislocation: the epiphyseal nucleus of the femoral head is located between the Y line and the parallel line of the upper edge of the acetabulum of the Y line. (iii) Third degree dislocation: the epiphyseal nucleus of the femoral head is located at the height of the parallel line of the superior acetabular rim. (iv) Degree IV dislocation: the epiphyseal nucleus of the femoral head is located above the parallel line of the superior margin of the socket, and there is pseudo-socket formation. Complications: Ischemic necrosis of the femoral head can occur regardless of conservative or surgical treatment, and re-dislocation and joint stiffness can occur after surgical treatment, which need to be prevented during treatment. Diagnosis is mainly based on physical signs and X-ray examinations and measurements. The examination of newborns also pays attention to the following points: (a) Appearance and skin texture When multiple malformations are associated with hip dislocation, the examiner often finds that the thighs and calves are not in proportion to each other, with the thighs being short and thick while the calves are long and thin, and the buttocks tend to be wide, with the inguinal crease being short or unclear. Different skin lines are seen on both sides of the buttocks when examined, and the affected side is usually elevated or increased by one, and the whole lower limb tends to feel shortened when the affected limb is externally turned by 15-20° when put on a leveling agent. (B) the femoral head can not be felt flexion of the hip and knee each 90 ° one hand holding the upper end of the calf, the other hand, the thumb placed in the inguinal ligament, the other 4 fingers placed in the buttock ring jump at the time of rotation of the hand when the calf, under normal circumstances in front of the femoral head can be found in the activities and protrusion. In subluxation, the front is empty while the four fingers behind the hip feel the femoral head moving. (C) Galeazzi’s sign (Galeazzi) will be children lying down, the two lower limbs flexion to 85 ° ~ 90 ° between the two ankles flat symmetrical position, found that the two knees have high and low, known as Galeazzi’s sign. Shortening of the femur and hip dislocation are all associated with this sign. (D) Adduction test (Otolani’s sign) will be children lying down, flexion of the knee, flexion of the hip 90 °, the physician will face the child’s hip will be grasped with both hands at the same time the two knees adduction, under normal circumstances, the two knees can be flattened and touched to the desktop. However, one side of hip dislocation cannot reach 90°, often between 65° and 70°, and the adductor muscle is obviously elevated, which is called a positive abduction test. There is abduction to 75 ° to 80 ° between the sliding or beating feeling, but later can be more abduction to 90 °, called Otolani beating sound, is an important basis for diagnosis. Sometimes the popping sound inside and outside the acetabulum and the meniscus beating sound of the color joint must be distinguished and not be confused with each other during the examination. (E) Joint loosening test The prerequisite for checking joint loosening is that the soft tissues around the femoral head are very loose, the muscles are not tense, and the femoral head can move up and down, into as well as out of the acetabulum. These tests include the following three methods: 1, Touma test (Thomas) in newborns will be the healthy leg flexed to the abdominal wall so that the waist anterior convexity disappeared, will be the affected side of the leg can be completely straight when straightened. Normal infants still have about 30 ° of flexion when straightening, and can be completely flat into a straight line. 2.Barlow test (Barlow) will be the affected limb bent at the knee so that the heel touches the buttocks. One hand holds the ankle joint as well as the size of the same side of the rump, the other thumb pushes against the pubic symphysis and the other 4 fingers against the sacrum. Halfway through abduction, the thumb is pushed to feel the femoral head dislocate backward, and when the thumb is relaxed, the bone is reintroduced into the joint. Positive Barrow’s test indicates that the joint is easily dislocated by laxity, but it is not hip dislocation. 3, set of test children lying down, flexion of the hip 90 ° bent knee 90 °, one hand holding the knee joint, the other hand pressure on both sides of the pelvis of the anterior superior iliac spine, will be pushed down the knee joint, can feel the head of the femur protruding backward, upward elevation, the femoral head back into the acetabulum, called as the set of test is positive. The above three groups of joint loosening inspection method is generally applicable to newborns, and can cooperate without crying and making noise in order to be correct, otherwise often can not check, therefore, there are still some limitations. (VI) Limping gait Although early diagnosis is very important, there are still many cases that come to the clinic because of limping. This type of gait can be seen with a little analysis in walking. Children walking when the affected limb in the weight-bearing phase (stagephase) is pelvic sagging, swaying, can not rise: in the swing phase (swingphase) is not obvious. The diagnosis is usually made after the child is walking, at the earliest from the age of 2 years, but it is treated later. The child with bilateral hip dislocation walks with a very pronounced pelvic side-to-side movement, often referred to as a duck-step waggle posture, with the hips protruding backwards and the lumbar spine protruding forwards, and the examination can easily lead to the thought of a hip dislocation. (G) Flexion test (Trendelenurg’s sign) This is an old method, which is rarely used at present. The child stands, and when the healthy side stands on one leg, the affected leg is raised and the pelvis is elevated upward on the same side. On the contrary, when the affected limb stands on one leg, the head of the femur on the affected side is not in the acetabulum, coupled with atrophy of the gluteal muscles, the hip joint is unstable, resulting in the pelvis drooping downward. (H) Rise of the greater trochanter in normal infants from the anterior superior iliac spine through the apex of the greater trochanter to the sciatic tuberosity is a straight line, called Nelaton’s line (Nelaton). If the head of the femur is not in the acetabulum and dislocates upward, the greater trochanter rises, and these three points are not in a straight line. X-ray clinical examination is the first step of diagnosis, it can only indicate that there is a problem with the hip joint, but the final diagnosis needs to be made by X-ray film. Within 2-3 months after birth, the epiphyseal ossification center of the femoral head has not yet appeared, and the X-ray examination relies on the relationship between the proximal end of the stem of the femoral neck and the acetabulum to measure. After the emergence of ossification center, the diagnosis can be determined by taking films including pelvic films of bilateral hip joints, when taking the films, both lower limbs together, pushing the affected limbs up and pulling them down to take a comparative measurement of each film, then the changes are more obvious and reliable. Measurement methods are as follows: (a) Perkin’s quadrant After the appearance of femoral head epiphyseal nucleus ossification, Perkin’s quadrant can be used to determine the dislocation of the hip joint. The horizontal line connecting the Y-shaped cartilage of the bilateral acetabulum (called Y line or Hilgenreiner line), the vertical line from the lateral ossification edge of the hip rim (called Perkin’s line or Ombredarne’s line), and the intersection of the two lines will divide the acetabulum into four zones, and the normal center of ossification of the femoral head should be in the inner and lower zones of the femoral head, and if it is located in the other zones, then it will be subluxation. If it is located in other areas, it is subluxation. The ossification center on the subluxation side is often smaller. (B) Acetabular index from the Y-shaped cartilage center to the acetabular rim for a line, the angle between this line and the Hilgenreiner’s line is called the acetabular index, this angle indicates the obliquity of the acetabulum is also the degree of development of the acetabulum (Figure 6). The normal value is 20° to 25°. At birth, the acetabular index ranges from 25.8 to 29.4°, and in 6-month-old infants, it ranges from 19.4° to 23.4° (Caffey 1956); for those over 2 years of age, it is within 20°. After children begin to walk, this angle decreases each year until it is essentially constant at about 15° at age 12 years. Most scholars consider more than 25° to be abnormal, while others consider more than 30° to be a significant tendency to dislocation. In recent years, the acetabular index of normal newborns has been found to be as high as 35-40°, and the vast majority of them later transform to normal hip joints. Therefore, the acetabular index should not be the only factor in the diagnosis. However, a greater than normal value indicates an increase in the inclination of the apex of the socket and acetabular dysplasia. In hip dislocation, this angle increases significantly, even above 30°. (C) Epiphyseal displacement measurement from the center of the femoral head epiphysis to the pubic symphysis central plumb line between the distance known as the paracentral distance, comparison between the two sides, there is a widening of the distance indicates that the head of the femur outward displacement. Commonly used in hip subluxation, this method is very valuable in the measurement of mild subluxation, before the appearance of epiphysis, the same can be used to measure the medial edge of the neck of the femur as a point. (D) Von Rosen line: Bilateral thighs are abducted 45-50° and rotated internally, and orthopantomograms are taken from the upper end of the femur to the pelvis bilaterally. Make a bilateral femoral mid-axis line and extend it to the proximal side, i.e. Von Rosen line. In normal cases, this line passes through the superior external angle of the acetabulum; in dislocation, it passes through the anterior superior iliac spine. Before the ossification center of the femoral head appears, it has some reference value for diagnosis. (E) Shenton (Shenton) line normal pelvic X-ray of the lower edge of the pubic bone arc line and the femoral neck of the medial arc can be connected to a complete arc called Shenton’s line. The integrity of this line is lost in all cases of hip dislocation and subluxation. This line disappears in any dislocation and therefore cannot distinguish between inflammatory, traumatic, congenital, etc. cases. However, it is still the simplest diagnostic method.Simon’s line: it is from the lateral margin of the ilium to the upper outer edge of the acetabulum, then downward and outward, forming a continuous longitudinal arc along the outer edge of the neck of the femur, and this arc is interrupted in the case of dislocation of the hip joint. (vi) Anterolateral angle radiograph of the femoral neck Occasionally radiographs are needed to further define the anterior tilt angle. The easiest way to do this is for the child to lie flat on his back with the hips upward for an orthopantomogram of the pelvis. Similarly, complete internal rotation of the thighs and then make a positive pelvic radiographs, will be compared to the two films can be seen in complete internal rotation of the neck of the femur the full length of the appearance of the head of the femur is clear, the hip bone upward when the head of the femur and the size of the thick rumble superimposed, it can be estimated that the anterior tilt angle of the existence of the. (G) Arthrography is seldom necessary to make a clear diagnosis, but it is occasionally necessary in some cases to clarify the causes of discoid cartilage, joint capsule stenosis, or failure of reset. Under general anesthesia, the hip joint is sterilized and aseptically operated, and a puncture is made in the anterior part of the joint for the injection of 1-3ml of 1-35% iodinated oil contrast agent (diodonediodast). Under fluoroscopy, it is possible to find out whether there is any obstacle on the outer edge of the acetabulum, the cartilage of the outer edge of the acetabulum and whether there is any stenosis of the joint capsule, and it is possible to make a clear picture of whether the head of the femur is completely into the acetabulum and whether there is any resetting and deformation of the disc cartilage again after manipulation of the reset, if necessary. Due to the complexity of the operation, insufficient filling of the contrast, and difficulty in reading the film, less people have applied the contrast diagnosis in recent years. (H) center edge angle ((center edgeangle, CE angle) that is, the femoral head center to the YY’ line of the vertical line with the outer edge of the acetabulum and the femoral head center of the line formed by the angle of its significance is to detect the acetabulum and femoral head of the relative position of the acetabular dysplasia or acetabular dislocation of the diagnosis of the value of the normal for the 20 ° or less. Follow-up cases often need to determine the degree of the femoral head into the acetabulum, Wibeng (Wibeng) take the center of the femoral head as a point, the outer edge of the acetabulum as a point, even the two points into a straight line. The outer edge of the acetabulum as a vertical line downward, the two lines into an obtuse angle at the outer edge of the acetabulum called the edge of the center angle. The normal range of this angle is 20-46°, average 35°; 15-19° is suspicious; less than 15°, or even negative angle, indicates that the head of the femur is outwardly displaced, subluxation or subluxation. Hip arthrography: in infancy, the femoral head is not yet ossified, and the majority of the hip joint is cartilage, which is not visible on X-ray film, so hip arthrography is helpful to observe the translucent part of the joint and soft tissue structure. The method is: the child lying down position general anesthesia, in aseptic operation, from the anterior superior iliac spine below 1.5 ~ 2cm inserted 18 with the core of the puncture needle, enter the skin downward, inward alignment of the acetabulum until the acetabulum, and then turned outward into the joint capsule injection of contrast medium in the normal hip joint can be observed: (1) the size and shape of the femoral head. (2) The cartilaginous rim of the acetabulum. (3) ring-shaped area that surrounds the joint capsule area can be seen transparent area around the femoral neck, the contrast agent will be divided into two (4) transverse ligament, manifested as the contrast agent within the lower pressure trace (5) round ligament, congenital hip dislocation, such as the glenoid rim of the joint turned inward, can be between the head of the femur and the acetabulum there is a filling defect, there is a clear contraction of the joint capsule, acetabulum with a band-shaped shadow indicates that the round ligament for the hypertrophy of the CT examination: some scholars have used the CT examination of infants and young children in some scholars recently. CT examination of congenital hip dislocation in infants and young children, can see the bone defect acetabular deformation caused by dislocation, and can see the bone changes, soft tissue embedded in the femoral neck of the anterior tilt and the degree of dislocation of the femoral head. The diagnosis of congenital hip dislocation in children can usually be confirmed by X-ray. To further understand the relationship between the head and the socket, three-dimensional imaging with spiral CT is feasible in order to provide a basis for surgery. For infants before the age of 6 months, as the ossification nucleus of the femoral head has not yet appeared, it is best to perform ultrasonography or MRI, and Von Rosen’s position radiographs can also be performed. Treatment The treatment of congenital hip dislocation should be strong early diagnosis, the best effect of treatment in infancy, the older the effect is worse, it is generally believed that the treatment after 2 to 3 years of age, even if very successful. After the age of 35 years, hip pain will occur, so most scholars emphasize the need for newborn census, so that early diagnosis and treatment is an important measure to get cured. Teratocarpal dislocation, there is no good treatment, usually need to be cut and reset, but the effect is not good. Typical congenital hip dislocation, if early and correct treatment, under the stimulation of normal function, the development of normal hip joint is very likely. Those treated within 3 years of age have a high cure rate. As age increases, the bony components of the femoral head and acetabulum increase, plasticity decreases, and pathological changes worsen, and it is difficult to achieve normal function despite correct treatment. Treatment methods include closed reset + brace, closed reset + frog cast; closed reset + rotational osteotomy to correct the anterior tilt angle; incision reset, and according to the different circumstances of the additional acetabular reconstruction and various osteotomies. Specific treatment principles are as follows: (a) from birth to 2 months without traction and anesthesia, can be used to flex both hips to 90 ° and then gradually abducted, put the thumb outside the greater trochanter to the front of the inner side of the push can be reset, reset should not be violent, such as reset success can be used to fix the bracket on the hip flexion 90 °, 70 ° of abduction, the fixation time of about 2 to 3 months, depending on the age of the time of reset. The brace should be removed after radiographic examination. There are many types of braces, including the abductor diaper pillow, the Begg plastic brace, and so on. The above two kinds of stents must be opened when changing diapers, which is more troublesome and less used at present.Barlow stent and Rosen stent are really effective, but there is pressure on the skin, which is prone to cause pain and pressure sores, and there is a possibility of ischemic necrosis of the femoral head.Pavlik stent can avoid the complications of violence-induced ischemic necrosis, and it makes use of the natural position of flexion of the two lower limbs at 90°, and the weight of the two lower limbs themselves to achieve abduction, so that it can be removed at the time of the restoration. It uses the natural position of the two lower limbs in 90° flexion and the weight of the two lower limbs themselves to achieve abduction, so that it can be naturally reset and maintained in the reset position, which is favorable to the development and shaping of the hip joint and has a certain range of motion of the hip joint. The disadvantage is that it is made of canvas, which is relatively hard, and if the shoulder and chest are wrapped too tightly, it will affect breathing, and if it is too loose, it will be easy to slip off, which will affect the treatment. (B) more than 3 months, 2 ~ 3 years of age in this group of cases due to dislocation for a long time, the soft tissues around the hip have varying degrees of contracture, and thus in the reset prior to traction, generally not more than 2 weeks, such as muscle contracture is more pronounced, it is necessary to make a reset before the release, such as the internal retractor muscle cut off, the iliopsoas muscle lengthening, etc., and then confirmed by the bedside X-ray, the position of the head of the femur has been with the level of the acetabulum, the use of surgical operations under general anesthesia If the position is satisfactory after reset, frog cast fixation will be applied. In order to adapt to the needs of pediatric growth and development, the cast should be changed once every 2 to 3 months, and each time X-ray film is needed to confirm the position of the femoral head in the acetabulum. If it is found to be dislocated again after replacing the cast, it must be reset again. Each time the cast is changed, the thigh is gradually adducted until the acetabulum develops normally before the cast is removed. If the reset fails, the presence of adipose fibrous tissue hyperplasia, hypertrophy of round ligament, dumbbell-shaped joint capsule, etc., which obstructs the femoral head from entering into the acetabulum, and thus needs to be incised and reset, should be considered. (C) above 3 years old to 8 years old, this group of children dislocated for a long time, the soft tissue contracture is more obvious, the acetabulum development is worse, often small and shallow, and the bottom of the acetabulum has a large number of adipose fibrous tissue, manipulation is extremely difficult to reset, and thus the vast majority of the need for incisional reset. However, it is necessary to do traction for 2 to 3 weeks before incision and reset until the femoral head is tractioned to the acetabular plane in order to perform surgical treatment. If the femoral head cannot be tractioned to the acetabular plane, it means that the soft tissue contracture is obvious, and if incision and reset are performed at this time, the possibility of ischemic necrosis of the femoral head will be very high, and thus the soft tissue must be loosened first, and then traction must be performed. After incision and reset, according to different situations, other surgeries are attached to the spinning operation: 1, femoral head capping surgery is generally applicable to children with subluxation, poor development of acetabulum, the femoral head can not be completely covered. There are three main types of this kind of surgery: (1) Pelvic osteotomy (Salter’s surgery): there must be a good reset before the surgery, such as manipulation reset is difficult, the surgery must also be cut and reset, and then pelvic osteotomy, the surgery must be under the osteotomy piece of the lower part of the bone forward and downward, in order to increase the femoral head of the covered surface and the stability of the hip joint. (2) Pelvic osteotomy and scaffolding (Chiari operation): this kind of operation must be carried out on a traction bed with X-ray surveillance, the positioning must be correct, the attachment point of the joint capsule must be clearly identified, the sciatic nerve may be damaged during the operation, and there are many chances of contamination during the operation, thus this method is less used at present. (3) Osteotomy around the joint capsule (Pemberton’s operation): this operation makes the upper part of the acetabulum forward and folded laterally to increase its coverage. A piece of bone is taken from the ilium and embedded in the pried open osteotomy to stabilize the reconstruction of the acetabulum. Postoperative cast immobilization. Zahradnick’s surgery is performed to deepen the acetabulum. After reset, due to the femoral neck anterior tilt angle is large, so the lower limb in the extreme internal rotation position to get reset, so must be in the rough rumble under the rotational osteotomy, and then use the steel plate screws fixed, postoperative plaster fixation, after 4 ~ 6 weeks after the removal of the first half of the plaster, exercise hip flexion and extension function, continue to be fixed at night. x-ray examination of osteotomies healed, you can get out of bed to carry on the functional exercise. For children above 8 years of age, it is difficult to perform incision and reset in general, and there are many complications, so it is not generally used for incision and reset, and some conservative surgeries aiming at stabilizing the hip joint are applied, such as acetabular implantation and capping, osteotomy of the femur at the end of the femoral opening. In recent years, the shortening of the femur is applied and then cut and reset, and the short-term efficacy is still acceptable. For adult congenital hip dislocation, generally more common in postpartum women, and more for the half dislocation, due to long-term in the abnormal hip joint weight-bearing situation, easy to cause traumatic arthritis, resulting in hip pain. For this kind of cases, the general use of closed-cell nerve cut can temporarily relieve pain, and if it has affected the function of the hip joint, then artificial total hip replacement surgery can be applied. Nursing measures for skin damage: 1. Instruct the family members of the affected children on the main points of skin care for cooperation. 2. 2.Scrub the whole body of the child every day. 3, timely replacement of baby diapers, regular reception of pediatric urine, urine and feces contamination in a timely manner after wiping, to keep the skin dry, to prevent the occurrence of diaper inflammation. 4.Keep the bed unit neat and tidy, prevent snacks and crumbs from grinding the skin. 5, for long-term bed-ridden children, check the skin condition every shift, change the position regularly, reduce the pressure on the skin, and prevent bedsores from occurring. 6, the use of support, plaster, traction, postoperative patients to prevent pressure sores. Keep sharp objects (knife, fork, scissors) and hot water bottles away from children to prevent stabbing and scalding. 8. Protect children who are unsteady in walking to prevent falls.