Settecerri J J, Karol L A
William Beaumont Hospital, Royal Oak, Michigan, USA.
J Pediatr Orthop. 2000 Nov-Dec;20(6):776-80. doi: 10.1097/00004694-200011000-00015.
This is a retrospective review of 144 hips in 99 patients treated with femoral varus osteotomy between 1975 and 1995. Average follow-up was 5 years (range, 2-15 years). The majority of patients (67%) were nonambulatory spastic quadriparetics. The average age at the time of surgery was 7.7 years (range, 3-15 years). Radiographic parameters analyzed were the neck-shaft and center-edge (CE) angles and Reimer's migration index (MI). Results were considered good if the CE angle was >20 degrees and the MI <30%, fair if the CE angle was 0 degrees - 20 degrees and the MI 30-50%, and poor if the patient had persistent pain, a CE angle of <0 degrees , or an MI >50%. Twelve hips (8%) remained painful at final follow-up, and 12 hips (8%) dislocated despite surgery. Previous surgery, unilateral surgery, performing a pelvic osteotomy, and age at the time of surgery had no statistical influence on outcome. Good results were obtained in 43.1%, fair in 41.5%, and poor in 15.4%. Only the quality of the reduction obtained at surgery, judged by the increase in CE angle and the reduction in MI, had a statistical influence on final result. Athetoid patients fared as well as those with spasticity. Femoral varus osteotomy was effective in providing a stable pain-free hip in 84% of patients.
这是一项对1975年至1995年间接受股骨内翻截骨术治疗的99例患者的144个髋关节进行的回顾性研究。平均随访时间为5年（范围为2至15年）。大多数患者（67%）为非行走性痉挛性四肢瘫患者。手术时的平均年龄为7.7岁（范围为3至15岁）。分析的影像学参数包括颈干角和中心边缘（CE）角以及赖默氏移位指数（MI）。如果CE角>20度且MI<30%，结果被认为良好；如果CE角为0度至20度且MI为30%至50%，结果为中等；如果患者持续疼痛、CE角<0度或MI>50%，结果则为差。在最终随访时，12个髋关节（8%）仍有疼痛，12个髋关节（8%）尽管接受了手术仍发生脱位。既往手术、单侧手术、进行骨盆截骨术以及手术时的年龄对结果均无统计学影响。良好结果的比例为43.1%，中等结果的比例为41.5%，差结果的比例为15.4%。只有手术时获得的复位质量（通过CE角的增加和MI的降低来判断）对最终结果有统计学影响。手足徐动症患者与痉挛性患者的情况相同。股骨内翻截骨术在84%的患者中有效地提供了稳定且无痛的髋关节。
