Sankar Wudbhav N, Spiegel David A, Gregg John R, Sennett Brian J
Children's Hospital of Philadelphia, PA, USA.
J Pediatr Orthop. 2006 Jan-Feb;26(1):1-7. doi: 10.1097/01.bpo.0000190842.77036.d0.
Twelve consecutive patients (average age 10.6 years) with 14 dislocated hips underwent one-stage hip reconstruction between 1973 and 1981. The procedure consisted of (1) adductor myotomy and anterior obturator neurectomy, (2) circumferential capsulotomy, iliopsoas and external rotator tenotomies, and ligamentum teres and pulvinar excision, (3) shortening femoral varus derotational osteotomy, (4) acetabuloplasty, and (5) spica immobilization for 4 weeks. All patients were followed clinically and radiographically at an average of 16.7 (range 12.4-19.5) years. No patients were lost to follow-up. Long-term results revealed complete stability in 13 of 14 hips, with no redislocations or subluxations. The one patient with "instability" had undergone bilateral proximal femoral resections for severe arthritis 12 years after left hip reconstruction; at the time of resection, the left hip was stable and reduced. Pain was absent in 13 of 14 hips. There were no problems with perineal care, decubitus formation, or sitting tolerance. Extension and abduction improved an average of 23 degrees and 10 degrees, respectively. Two patients' ambulatory status improved; none deteriorated. The mean center-edge angle was 35 degrees (range 22-50 degrees), and the mean migration percentage was 10.6% (range 0-31%). Complications included one case of degenerative arthritis, one case of painless coxa vara, and three episodes of supracondylar femur fractures. None of these patients developed radiographic evidence of avascular necrosis. In the authors' experience, one-stage hip reconstruction consisting of soft tissue lengthening, open reduction, femoral osteotomy, and pericapsular acetabuloplasty results in a painless, mobile, and stable hip at long-term follow-up that greatly improves the patient's quality of life.
1973年至1981年间，连续12例（平均年龄10.6岁）共14个髋关节脱位的患者接受了一期髋关节重建手术。手术步骤包括：（1）内收肌切断术和闭孔神经前支切除术；（2）环形关节囊切开术、髂腰肌和外旋肌肌腱切断术，以及圆韧带和髋臼垫切除；（3）股骨缩短内翻旋转截骨术；（4）髋臼成形术；（5）髋人字石膏固定4周。所有患者均接受了平均16.7年（范围12.4 - 19.5年）的临床和影像学随访。无患者失访。长期结果显示，14个髋关节中有13个完全稳定，无再次脱位或半脱位。1例“不稳定”患者在左髋关节重建12年后因严重关节炎接受了双侧股骨近端切除术；切除时，左髋关节稳定且复位良好。14个髋关节中有13个无疼痛。会阴护理、褥疮形成或坐位耐受方面均无问题。伸展和外展分别平均改善了23度和10度。2例患者的行走状态改善；无患者恶化。平均中心边缘角为35度（范围22 - 50度），平均移位百分比为10.6%（范围0 - 31%）。并发症包括1例退行性关节炎、1例无痛性髋内翻和3次股骨髁上骨折。这些患者均未出现缺血性坏死的影像学证据。根据作者的经验，由软组织延长、切开复位、股骨截骨术和关节囊周围髋臼成形术组成的一期髋关节重建术，在长期随访中可使髋关节无痛、活动且稳定，极大地改善了患者的生活质量。
