Canavese F, Sussman M D
Department of Orthopedics, Shriners Hospital for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Hip Int. 2009 Jan-Mar;19 Suppl 6:S46-52. doi: 10.1177/112070000901906s08.
Joint contractures, subluxation and dislocation are common problem in children with neuromuscular disorders. Medical, surgical and rehabilitative approaches can be used to maintain patient function and comfort. Contracture release, hip dysplasia correction and procedures to address or prevent hip subluxation or dislocation, are not always necessary since patients can be asymptomatic and surgical treatment will not always be successful in maintaining a reduced hip. In fact, controversy surrounds the management of hip disorder in children with Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita. Patients with neuromuscular disorders also frequently develop a progressive scoliosis with pelvic obliquity which may affect sitting balance and become painful. Most subluxations and dislocations have the tendency to occur on the high side of a tilted pelvis. Spinal stabilisation is sometimes necessary to improve the pelvic tilt and to prevent further increase. The present article provides an overview of the current strategies of hip management in neuromuscular disorders.
关节挛缩、半脱位和脱位是神经肌肉疾病患儿的常见问题。可采用医学、外科和康复方法来维持患者的功能和舒适度。由于患者可能无症状，且手术治疗不一定能成功维持髋关节复位，因此并不总是需要进行挛缩松解、髋关节发育不良矫正以及处理或预防髋关节半脱位或脱位的手术。事实上，对于患有杜氏肌营养不良症、脊髓性肌萎缩症、夏科-马里-图斯病和先天性多发性关节挛缩症的儿童，髋关节疾病的治疗存在争议。神经肌肉疾病患者还经常出现伴有骨盆倾斜的进行性脊柱侧弯，这可能会影响坐姿平衡并引起疼痛。大多数半脱位和脱位倾向于发生在倾斜骨盆的高位侧。有时需要进行脊柱稳定手术来改善骨盆倾斜并防止其进一步加重。本文概述了神经肌肉疾病中髋关节治疗的当前策略。
