Bassett G S, Engsberg J R, McAlister W H, Gordon J E, Schoenecker P L
St. Louis Children's Hospital, Missouri, USA.
J Pediatr Orthop. 1999 Jul-Aug;19(4):425-32. doi: 10.1097/00004694-199907000-00002.
We evaluated the anatomic and functional consequences of psoas lengthening during operative intervention for developmental dislocation of the hip (DDH). Possible anatomic changes were assessed by magnetic resonance imaging (MRI), and functional assessment included strength determination by an isokinetic dynamometer and gait analysis. Six girls and one boy, ranging in age from 15 to 20 months, had operative reduction of a unilateral DDH. One closed and six open reductions (three anteromedial and three anterolateral approaches) were performed. Follow-up ranged from 4 years 0 months to 9 years 2 months. The cross-sectional area determined by MRI of the lengthened psoas muscles was markedly reduced for all of the six open-reduction patients (three moderate and three severe). Atrophy of the iliacus muscle also was apparent by MRI in five of the six open-reduction patients. Maximum flexion torque, as determined by the isokinetic dynamometer, was diminished on the DDH side for the three patients whose hips were reduced open through the anteromedial approach. Average hip-flexion torque over the entire range of motion was decreased for both anteromedial and anterolateral groups on the operated-on side. Lengthening of the psoas tendon during open reduction of a DDH is associated with considerable atrophy of the psoas muscle.
我们评估了在髋关节发育性脱位（DDH）手术干预过程中腰大肌延长的解剖学和功能后果。通过磁共振成像（MRI）评估可能的解剖学变化，功能评估包括使用等速测力计测定肌力和步态分析。6名女孩和1名男孩，年龄在15至20个月之间，接受了单侧DDH的手术复位。进行了1次闭合复位和6次开放复位（3次前内侧入路和3次前外侧入路）。随访时间为4年0个月至9年2个月。在6名接受开放复位的患者（3名中度和3名重度）中，通过MRI测定的延长腰大肌的横截面积均明显减小。在6名接受开放复位的患者中，有5名通过MRI也显示出髂肌萎缩。对于3名通过前内侧入路进行髋关节开放复位的患者，通过等速测力计测定的最大屈曲扭矩在DDH侧减小。手术侧前内侧组和前外侧组在整个运动范围内的平均髋关节屈曲扭矩均降低。在DDH开放复位过程中腰大肌腱的延长与腰大肌的明显萎缩有关。
