Home Traction Program in Tretment of Congenital Dislocation of the Hip

在家牽引法於治療先天性髖關節脫臼效果之評估

黃世傑(Shier-Chieg Huang) ； 劉華昌(Hwa-Chang Liu) ； 劉堂桂(Tang-Kue Liu)

《Journal of Orthopaedic Surgery Taiwan》 5卷2期 (1988/06) Pp. 162-169

摘要

在治療先天性髖關節脫臼時，事先的牽引術有助於脫臼之復位及減少股骨頭缺血性壞死的發生。由於考慮醫療費用之高漲，1974年就有人開始嘗試在家牽引法。為了評估此法在我國運用之可能性、效益及問題，我們作此前瞻性之研究。
從民國73年4月到75年10月，我們以在家牽引法運用於20位病童（22個髖脫臼）。經過2─3週的牽引，所有的髖脫臼都能順利復位，並以石膏及支架治療。在追蹤一年到3年6個月（平均2年5個月）的時間內，有三個病例的股骨頭發生輕度的缺血性現象，其發生率為13%。所有病人對此牽引法的適應都很好，也只有少數皮膚及牽引的問題而已。運用此法的費用亦極低廉。
雖然目前對先天性髖關節脫臼治療前牽引的價值、方法及時間仍有些爭論，但已有不少人報告，事先的皮膚牽引的確有助於推臼的復位及股骨頭缺血性壞死的減少。而在家牽引術更有不必住院或縮短住院時間，降低醫療費用，維持正常家庭生活或減少精神上的困擾等優點。其併發症及問題與在醫院牽引法相近或更低。所以我們認為大部份在學步前後發現的髖關節脫臼病人，在家牽引法值得運用。

並列摘要

Premanipulative traction in the hospital has been used for many years. Its purpose is to facilitate the reduction and to decrease the incidence of avascular necrosis of the femoral head in the treatment of congenital dislocation of the jip (CDH). Because of increasing financial concerns, home traction programs were first initiated in the United States in 1974 and have gained some degree of popularity throughout the world. To evaluate the efficacy and problems of applying this program in our country, we conducted this prospective study.
From April ’84 to Oct. ’86, 20 children with 22 dislocated hips were applied with a home traction program before closed reduction and casting. All of the dislocated hips were reduced gently and successfully. Bilateral hip spica was applied in a human position. Three months later, it was changed to a brace treatment. In follow-ups from 12 months to 3 years 6 months (average 2 years 5 months), three hips developed a mild degree of avascular necrosis within 10 months of the initial treatment. The incidence of a mild degree of avascular necrosis was 13%. The compliance of the patients was good. Minor problems regarding skin irritation and techniques of application were easily solved by teaching, constant counseling and encouragement. The cost was also very low.
Although there was still some controversy about the value, direction and period of traction, premanipulative skin traction has been reported to be effective in decreasing the incidence and severity of avascular necrosis in the treatment of congenital dislocation of the hip. The home traction program had the additional advantages of shorter hospital stays, less cost, no interruption of family life and less psychological impact. Complications and problems were comparable or even less than in –hospital traction programs. Home traction had definite advantages and could be applied in most of cases of CDH around the walking age.

並列關鍵字

Home traction ； congenital dislocation of the hip