Treatment of congenital hip dislocation

The principle of treatment for this disease is early diagnosis and prompt treatment. Once the diagnosis of congenital hip dislocation is established after birth, treatment should be started immediately, and it is expected to obtain a hip joint with near normal function. The older the age at the beginning of treatment, the worse the results. 1. Conservative treatment The theoretical basis of conservative treatment is Harris’ law, which states that concentric head and socket is the basic condition for hip development. In order to achieve the stability of the hip joint after repositioning, the following conditions must be met: ① Select a position that maintains the stability of the hip joint; the traditional frog position is the ideal position, but it is not conducive to the blood supply to the femoral head. ②Select a brace, splint or plaster fixation according to the different ages of the patient. It is required to be stable, comfortable, convenient and easy to manage urine and stool, and it is best to keep the hip joint moving properly. ③Select the most suitable age for hip joint development, the younger the better, generally under 3 years old is appropriate. ④The ratio of head and socket should be proportional, if the ratio is out of proportion, the stability of the hip joint cannot 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 the fixation is removed. It usually takes 3-6 months, and the younger the patient is, the shorter the fixation time. 2. Surgical treatment (1) Salter pelvic osteotomy Salter surgery, in addition to repositioning the femoral head, mainly changes the abnormal acetabular direction to the normal physiological direction, relatively increases the acetabular depth, and makes the femoral head and acetabulum reach concentric. This procedure can be used for hip dislocations aged between 1 and 6 years old, including those who have failed in manual repositioning. (2) Pemberton acetabularplasty is performed by osteotomy through the slope of the parallel acetabular roof 1 to 1.5 cm above the upper edge of the acetabulum, prying up the acetabular end downward and changing the inclination of the acetabular roof so that the acetabulum can fully accommodate the femoral head and bring the acetabulum into normal shape. This procedure can be used if the age is over 7 years old or if the acetabular index is over 46° under 6 years old. (3) Femoral rotational osteotomy and femoral shortening osteotomy Femoral rotational osteotomy is suitable for those with an anterior tilt angle of 45° to 60° or more, and should be performed simultaneously with the above-mentioned surgery. The osteotomy is usually performed under the lesser trochanter, usually with a wire saw, and after the osteotomy, the proximal osteotomy end is internally rotated or the distal osteotomy end is externally rotated and fixed with a 4-hole plate, but care should be taken not to over-correct. Femoral shortening osteotomy is suitable for those who are older and have Ⅲ degree dislocation, especially those who do not have preoperative traction in place, and also osteotomy under the lesser trochanter, shortening about 2 cm, and can also correct excessive anterior tilt at the same time, and then also fixed with 4 hole plate.