선천성 고관절(股關節) 탈구(脫臼)에 관한 임상적 연구

Abstract

[한글]

[영문]

Congenital dislocation of the hip has always presented an unique problem in Orthopedic surgery. Orthopedic surgeons have been baffled not only by the mystery of its origin, but also by its unpredictable course and the uncertainty of results of treatment.

Hippocrates described this condition first with all its distinguishing characteristics, including distortion of the hip, the pathologic gait, the exaggerated lordosis, etc. His prognosis in this "luxation of early childhood" appeared to be unfavorable.

In 1895, Lorenz established a new, decidedly conservative method of treatment. His process involved a complete separation of the two objectives to be fulfilled, namely reduction and retention. To retain this reduction he conceived the motion of

fixing the hip for a specific and prolonged period in carefully chosen "primary position" of 90° flexion and 90° abduction by forcibly maintaining the head in its normal location.

Ortolani, in 1935, was the first to show that a diagnosis could be established immediately after birth. The jerk, click or snap elicited by manipulation of the new born infant's hip.

Early diagnosis is still the most important aspect of congenital dislocation of the hip. Despite the emphasis on early diagnosis, a disturbingly large number of congenital dislocation of the hip remain undiagnosed until after the child has started to walk.

Numerous surgical procedures and modifications have been used. The general types are: 1) Open reduction, 2) Shelf procedure, 3) Innominate osteotomy, 4) Arthroplasty, and 5) femoral osteotomy. These procedures have been useful also with the more difficult problem of residual or recurrent dislocation or subluxation

after treatment by closed or open method.

Congenital dislocation of the hip was not common in Korea like as in western countries. The reasons for this are poorly understood. But racial differences and native customs may offer a partial explanation.

The author studied congenital dislocation of the hips in sex incidence, site of predilection, clinical symptoms and signs, X-ray findings, relation to the congenital anomalies and birth history, and the results of treatment. In this study, 57 cases of congenital dislocation of the hip, admitted to the orthopedic

department of Severance Hospital during 7 years and 6 months since January 1963 until June 1970, were reviewed.

The results of this study are as follows:

1. The annual changes of the numbers of the patients, who were first seen at Severance Hospital, were increasing.

2. The female incidence in Korea is relatively low as compared with the western countries. And the preponderance of females over males is in the ratio of ten to one in bilateral cases and two to one in unilateral cases.

3. The ratio of bilateral cases: right sides: left sides is 1: 2: 2.2.

4. In these series, 15 cases of congenital anomalies or diseases in 13 patients are combined and among them, 10 patients are included in teratologic groups. And most common co-existing anomalies are club foot (7 cases). The incidence of the teratologic dislocation in Korea is relatively high as compared with the western countries.

5. The acetabular index in affected hips showed no relationship to the age factor, but C-E angle, Y-coordinate and height are aggravated according to the increment of age.

6. Closed reduction is satisfactory under the age of 3, but after than the prognosis is poor.

7. Open reduction is recommendable after the age of 3 and under the age of 9.

8. The prognosis of treatment in bilateral cases and teratologic groups is poor.