To Study On Clinical Results Of Open Reduction Through Ferguson Approach In DDH And Anatomic Exploration Of Procedure

Objective: To study the clinical results of the open reduction through Ferguson approach, comparising with the closed reduction in treatment of developmental dislocation of the hip(DDH).To explore the methods and reliability of the open reduction via Ferguson approach .Methods: Sixty-six dislocation hips in 52 patients (age: six months to two years old) were retrospected. Twenty patients (25 hips) were primarily reduced by open reduction through Ferguson approach, and thirty-two patients (41 hips) were treated by closed reduction. The pelvic AP plain radiography were taken in prereduction and after reduction of one week, three and nine to twelve months. The research items including CT (the femoral capital-tear drop distance), AI (acetabular index), the rate of AVN(avascular necrosis) and redislocation ,and the horisonal and vertical diameter of the femoral epiphisis were measured from AP films. the value of two methords were analyzed statistically.Refering to practical operational material and reference of Ferguson approach, the hips of children corpse were anatomized and the operational step were illustrated, comparising with the other medial open reduction methords ,the lesion of the operation through Ferguson approach were discussed.Results: In reduction via Ferguson approach group, the femoral capital-tear drop distance (CT) value of prereduction between the norma(l15.18±2.63mm) and abnormal hips(24.04±3.63mm) were significant difference (analyzed statistically P<0.05) , were not significant difference (analyzed statistically P>0.05) after reduction one week, three and nine to twelve months, CT value were decreased after three months(20.68±3.26mm) versus one week(22.67±2.88mm) and were significant difference (analyzed statistically P<0.05). While in reduction by closed approach group, CT value of prereduction between the normal(13.10±2.10mm) and abnormal hips(20.32±3.74mm) were significant difference (analyzed statistically P<0.05), were not significant difference (analyzed statistically P>0.05) after reduction one week and three months, but were significant difference (analyzed statistically P<0.05) after reduction nine to twelve months, abnorma(l14.50±1.78mm) were larger. CT value were not decreased after three months(21.32±2.38mm) versus one week(21.53±2.69mm) and were not significant difference (analyzed statistically P>0.05) .The rate of AVN and redislocation of the abnormal hips between two approaches were not significant diffrence (analyzed statistically P>0.05), although the group of treatment by Ferguson approach wase lesser.The medial incision of Ferguson approach can avoid the femoral neurovascular bundle and inguinal lymph, the blood loss is usually minimal and the residual scar is cosmetically acceptable. After blunt dissetion between the adductor longus and brevis with the adductor magnus and gracilis, the inferior-medial capsule is visualized and the primary obstacle to reduction, such as the iliopsoas tendon, the transverse acetabular ligament and constricted capsule, are easily released, the entrance of the acetabular can be enlarged. Bringing the femoral head into the acetabular under direct vision, the operater can confirm inadequate reduction and determine stable safe zone. Hypertrophy fibrofaty pulvinar and the ligamentum teres which obstruct reduction should be removed for concentric reduction. The medial femoral circumflex artery or its branches traverses across the medial hip capsule, that can be indentified and preserved easily, the capsule is exposed superior it and lesser trochanter is touched inferior it. When the adductor longus was exsected at its origin, the external pudendal artery and vein should be preserved ,which accrosses the origin of the adductor longus. Superficial medial femoral vein or its branches was ligated for crossing the operation incision. Comparising Ferguson approach, the incision of Weinstein medial approach adjoin the femoral neurovascular bundle which was retracted during operation and Ludloff approach can demage the anterior branch of the obturator nerve. Ferguson approach is more posterior than Ludloff methods,and is suited for DDH. Ferguson approach is also easier to learn.Conclusions: In treament of DDH between six to two years old, the open reduction via Ferguson approach is safe and effective, the acetabular recovery and development is satisfied, the rate of AVN and redislocation is lesser, we positively adovocate this medial approach.The open reduction via Ferguson approach is reliability, for the minimal blood loss ,dissection intermuscle, the residual scar cosmetically ,and slightly demage. It can easiy release the soft tissue which block reduction and display the acetabular clearly. Under direct vision,the reduction is adequate. Comparising with other medial open reduction,it is safe and lesser disturb near structure.