There were 120 cases of high congenital hip dislocations in children of III-IV degree within the age of years and 4~5 years old. After 1~5 years of follow-up, the reset failure rate was < 0.17%, and the cure rate was 98% without complications such as joint ankylosis. The results were excellent (30~26 points) in 106 cases; good (25~21 points) in 12 cases and poor in 2 cases. It is believed that this method can make the large age dislocation reach concentric circle reset, the femoral head and acetabular epiphysis get stress stimulation at an early stage, and the epiphysis can develop rapidly and restore normal joint function. Treatment Fracture fixation Multi-functional abduction brace Clinical study Pediatric congenital hip dislocation is the most common type of deformity of the limbs, early detection and early non-surgical treatment is preferred by scholars at home and abroad. However, the traditional fixation method for 3 years old (Ⅲ ~ Ⅳdegree) dislocation has the shortcomings of low success rate and high rate of femoral head necrosis. Since 1990~March 2003, the authors used manipulative positioning multifunctional abduction brace to treat 120 cases of pediatric congenital hip dislocation, with a follow-up of 1~5 years, and the results are reported as follows. 1.Clinical data In this group, there were 120 cases, 103 female and 17 male, 60 cases of Ⅲ degree and 20 cases of Ⅳdegree in 3 years old; 18 cases of Ⅲdegree and 14 cases of Ⅳdegree in 4 years old; 5 cases of Ⅲdegree and 3 cases of Ⅳdegree in 5 years old. There were 26 cases with acetabular angle 30~35°, 39 cases with 36~40°, 33 cases with 41~45°, and 22 cases with 46~60°.There were 12 cases with Acmcidelbr angle 30~35°, 30 cases with 25-29°, 35 cases with 20-24°, 20 cases with 15-19°, 16 cases with 10-14°, 6 cases with 5-9°, and 1 case with less than 3°. There were 75 cases with cervical trunk angle of 130~140°, 36 cases with 141~150°, 8 cases with 151~160°, and 1 case with 168°. There were 28 cases with anterior tilt angle of 25~35°, 56 cases with 36~45°, 20 cases with 46~50°, 10 cases with 51~60°, and 6 cases with 61~70° according to Qqata's introduction of the X-ray biplane method. There were 26 cases of femoral head dysplasia according to the ratio of 1/2 type Ⅳ, 36 cases of 1/3 type Ⅲ, 51 cases of 1/4 type Ⅱ, and 7 cases of 1/5 type Ⅰ. 2, treatment methods 2.1 reset method The child is placed in the brace supine, to the left side, for example, the operator first manipulative massage of the affected side of the adductor muscle group for one minute, so that the muscle group relaxation, generally do not use anesthetics, commonly used via the posterior margin reset method, the assistant four-finger fixation of the left side of the pelvis of the iliac bone anterior superior spine part, place the thumb on the top of the femur big thick ronda, the operator stood on the side of the affected person, both hands holding along the lower part of the thigh at the same time flexion of the hip, the knee joint sustained longitudinal axial traction 1-2 minutes, one side to make its internal rotation, internal retraction; when the hip flexion to 0 ~ 140 °, the assistant thumb inward against the large thick rumble as a lever fulcrum, the large thick rumble to the acetabulum at the same time the thigh abduction 0-80 °, the femoral head can be resumed into the socket through the posterior border of the acetabulum, the operator's hand has a "bone fall" feeling. The operator's hand has the feeling of "bone falling". Put the thigh into the fixation set, keep the hip flexion 120-140° abduction between 70-80° fixed, the same reset method to fix the right side. The reset process is completed under TV C-arm monitoring. 2.2 Stent structure Stent Patent No.: (92221465X) is made of aluminum plate in order to permeate X-ray, and covered with soft material to achieve elastic protection. Attachment: 1. foot turning inside out plate; 2. single pin joint; 3. internal rotation plate; 4. double bolts fixed wire; 5. calf connecting plate; 6. single pin joint; 7. thigh connecting plate; 8. double screws fixing plate; 9. thigh fixing set; 10. thigh fixing set single bolts adjusting wire; 11. spreading plate; 12. frog Bei's adjusting fixing wire; 13. back support; 14. waist belt; 15. back strap; 16. Screw fixation holes; 17. Elastic contraction holes. 2.3 Method of use After manual reset, adjust the frog period, maintain hip flexion 120~140 °, abduction 70~80 °, fixation period for 3 months; frog stabilization period for 2 months; adjust the hip flexion 80~90 °, abduction 70~80 °, bei mortise cap period, maintain bilateral lower limb abduction 40~50 °, internal rotation 30~40 ° to maintain fixation for 3 months. Precautions: observe the direction of femoral head dislocation, measure the anterior tilt angle, and relax the internal muscle group before reset, if the reset fails, find out the reason of failure, avoid rough manipulation, insufficient traction, and not find out the reason of obstruction of reset, and avoid the epiphyseal injury of the femoral head caused by multiple repeated reset. The thigh fixation set should be kept at 0.5cm gap to prevent too tight compression of blood flow in the lower limbs, and too loose fixation is not reliable. Monthly radiographs are taken to observe the femoral head and acetabular gap and development, and to adjust the treatment angle. Observe the reliability and stability of stent fixation. 3.1 Efficacy evaluation standard According to Zhou Yongde [1] congenital hip dislocation efficacy evaluation standard, (1) clinical function evaluation: including subjective feeling, clinical examination; (2) X-ray examination evaluation: including femoral head, acetabular development and "Y"-shaped cartilage development and closure, and comprehensive evaluation of the hip joint gap. Criteria: 26~30 is excellent, 21~25 is good, 16~20 is acceptable, 11~15 is poor. 3.2 Results of efficacy evaluation 〈1〉The 120 cases in this group were followed up for 1~5 years, 118 cases were cured, accounting for 98.3%, and 2 cases of reset failure, accounting for 0.17%. According to the criteria for evaluating the efficacy of congenital dislocation of the hip, 106 cases were excellent (30~26 points), 12 cases were good (25~21 points), and 2 cases were poor, with an excellent rate of 98.3%. 4.Discussion 4.1 Manipulative reset of the angle of abduction and ischemic necrosis of the femoral head Due to the upward dislocation of the femoral head with flexion and abduction of the hip at 90°, the adductor muscle is on a vertical maximum tension line, so that the proximal end of the femoral head is pressed on the posterior aspect of the acetabulum, and the hip pressure is increased and results in the compression of the femoral head on the external side of the femur head with many acetabular indentations, and the individual femoral tube is occluded, which leads to ischemic changes. According to Zhao Qun and other animal experiments, there are acetabular indentations on the outer side of the femoral head, and there are obvious depressions on the individual side, which suggests that the pressure between the acetabulum and the head of the femur increases unevenly and the pressure suffers from the compression, which affects the blood supply of the lateral spinous artery that forms the basilar artery of the femoral neck, and naturally, it also affects the source of the internal and external arteries of the femoral head, which results in the dysplasia or necrosis of the femoral head, and that is why most of the scholars propose to cut off the medial retractor muscles. Therefore, most scholars propose to cut off the adductor muscle group to reduce the necrosis of the femoral head. However, this will affect the stability of the hip joint. With abductor brace, without cutting off the adductor muscle, hip flexion over 120°, abductor angle 70~80°, change the direction of the hip joint tension line, break down an upward and inward force, reduce the inward joint pressure, use the muscle tension of the gluteus maximus and adductor muscle traction reset is stable and reliable, during the period of treatment, parents are instructed to drag the thigh holster frequently, with the thigh pulling the holster as a pivot, using the weight of the affected child's own body, and downward force is divided to drive the femoral head; using the muscle tension, the femoral head will be driven; using the muscle tension of the hip muscle and adductor muscle, the femoral head will be driven. The head of the femur is driven; the muscle tension is used to stimulate the development of the head and the socket, like a timed clock striking the hour, so that the head of the femur and the acetabulum often friction, the acetabulum is stimulated by the role of stress to gradually deepen the development of the femoral head, the femoral head epiphysis gradually increased, and the use of adductor and iliopsoas muscle tension to achieve the therapeutic purpose of the combination of static and dynamic, stable and reliable. We observed that the relationship between the femoral head and acetabulum was normalized in 6 cases after three-phase treatment, but the femoral head was still underdeveloped, which manifested that the epiphyseal surface was not smooth, fragmented or the head epiphysis was small. Blood circulation of the femoral head in the reconstruction period epiphyseal plate cartilage is an active physiological process, the epiphyseal plate subchondral mast cells in the process of differentiation secretes a chondrogenic growth hormone, which has the function of promoting the growth of blood vessels, calcification of the matrix and bone formation, and all of them can reach normal after 1~5 years of gradual development. Most scholars recognize that 3 years old is the dividing age between non-surgical and surgical, and above 4 years old must be operated, because of the high rate of necrosis of the femoral head and the epiphyseal closure of the acetabular angle. After clinical observation, as long as we achieve concentric reset, we can still restore normalization and achieve recovery by stimulating the development of head and socket under the effect of stress in three phases. Therefore, we believe that 4~5 years old is still the period of acetabular development, and we must not give up non-surgical treatment easily. 4.2 Problem of self-correction of anterior tilt angle Newborn's anterior tilt angle is 20~35°, the average angle is 25°, and its angle decreases gradually with age, in congenital hip dislocation, the increase of anterior tilt angle is one of the pathologic changes. The contracture and pulling effect of iliopsoas muscle and internal retractor muscle prevent the hip joint from developing under normal biological force, so the increase of anterior tilt angle affects the hip joint reset and acetabular development and hip joint function after reset, and even there is a possibility of re-dislocation. According to Wang Chengwu, anterior tilt greater than 40° must be corrected to maintain stable reset. We use the brace abduction angle to adjust the correction according to the anterior tilt angle, the anterior tilt angle in 30~40° will be fixed by adjusting the abduction angle 80°; the anterior tilt angle 41~50° will be fixed by adjusting the abduction angle 70°; the anterior tilt angle 51~70° will be fixed by fixing the abduction angle 60~70°. In the treatment, 5 special cases were found to have acetabular depth of 3~5mm, anterior inclination angle of 56~70°, routine external booth X-ray orthopantomograph showed normal acetabular relationship, and the femoral head was detected forward dislocated at the anterior side of the acetabulum in the groin, the adjustment of the abduction angle of 60° or so, adjusted once every 2 months, and gradually increased to the limit of 10 °, and under the action of muscle tension traction, after three phases of treatment, the gradual correction of the self-reliance to achieve the rehabilitation purpose. The result of this treatment is a gradual self-correction and rehabilitation. Therefore, we believe that it is not easy to correct the anterior tilt angle by surgical osteotomy. 4.3 The characteristics of the functional recovery period of the Bay style stenting cap Congenital hip dislocation socket outer rim due to the lack of the femoral head extrusion further makes the acetabular angle smaller, the head to the acetabulum outside the iliac bone detachment to make the acetabulum outside the iliac wing appeared to be concave, the acetabular angle was slope, stenting treatment key is to control the thigh abduction 40 ~ 50 °, internal rotation of 30 ~ 40 ° position, so that the acetabular angle to get the stress stimulation of the rapid development; so we are in the thigh holster fixation connectivity Therefore, we fixed 2 plates in the thigh holster, consisting of knee and ankle axial joints, which can automatically elastic expansion and contraction, flexion and extension of the knee and ankle joints, and external rotation plate control on the lateral side of the foot, so that the child can wear the holster in the shoes to play the role of internal rotation of 30~40°, to keep the femoral head abducted and internal rotation, to avoid external rotation of the femoral head from dislodging, and to play the role of static and dynamic when the child is load-bearing, and to lift the stent so that the child can walk normally. After 120 cases of treatment observation, the multifunctional abduction brace fully embodies the principle of combination of motion and static, and utilizes multi-angle adjustment for stable and reliable treatment, with high cure rate and no complications such as joint ankylosis, providing a new treatment method for congenital hip dislocation.