Inan Muharrem, Bowen Richard J
Inonu University Medical Faculty, Orthopaedic Department, Malatya, Turkey.
Clin Orthop Relat Res. 2005 Nov;440:192-8. doi: 10.1097/01.blo.0000180602.00487.47.
Pelvic support osteotomies for chronically dislocated hips improve stability but result in limb-length discrepancy and valgus deformity of the knee. We prospectively evaluated and followed up 16 patients (14 females, two males) to ascertain whether a monolateral external fixator could achieve a pelvic support osteotomy and eliminate the limb-length discrepancy without disturbing knee motion. The patients had a mean age of 25.3 years at the time of surgery. The Harris hip score, knee range of motion, and Trendelenburg sign were evaluated preoperatively and at followup. The average time from fixator application until removal was 7 months (range, 5.2-9.5 months). The followup averaged 52.5 months (range, 26-84 months). The mean Harris hip score increased from 50 points (range, 32-73 points) preoperatively to 87.6 points (range, 67-98 points) at last followup. Four patients retained a positive Trendelenburg sign. At the time of fixator removal, 88% of preoperative knee range of motion was retained, and preoperative knee motion was achieved at last followup in all patients. The monolateral external fixator was suitable for a pelvic support osteotomy, equalizing limb-length discrepancy, and obtaining lower extremity alignment. This method achieved a pain-free, functional hip and good knee motion.
Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.
用于慢性髋关节脱位的骨盆支撑截骨术可提高稳定性，但会导致肢体长度差异和膝关节外翻畸形。我们对16例患者（14例女性，2例男性）进行了前瞻性评估和随访，以确定单侧外固定器能否实现骨盆支撑截骨术并消除肢体长度差异，同时不影响膝关节活动。患者手术时的平均年龄为25.3岁。术前及随访时评估Harris髋关节评分、膝关节活动范围和Trendelenburg征。从应用固定器到拆除的平均时间为7个月（范围为5.2 - 9.5个月）。随访平均为52.5个月（范围为26 - 84个月）。Harris髋关节评分的平均值从术前的50分（范围为32 - 73分）增加到末次随访时的87.6分（范围为67 - 98分）。4例患者Trendelenburg征仍为阳性。在拆除固定器时，保留了术前膝关节活动范围的88%，所有患者在末次随访时均恢复到术前膝关节活动度。单侧外固定器适用于骨盆支撑截骨术，可均衡肢体长度差异并实现下肢对线。该方法实现了无痛、功能良好的髋关节和良好的膝关节活动。
治疗性研究，IV级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
