Cobeljić Goran
Srp Arh Celok Lek. 2009 Nov-Dec;137(11-12):697-701. doi: 10.2298/sarh0912697c.
Paralytic dislocation of the hip in adolescence is not typical, but presents a serious problem whether diagnosed primarily in adolescence or due to the lack of treatment or failed treatment in earlier age. It is characteristic of cerebral palsy and myelomeningocele. If the paralytic dislocation of the hip in adolescence is asymmetric, then pelvic obliquity, leg-length discrepancy, imbalance in sitting position, scoliosis and secondary spondylosis with all its consequences ensue. Complications like hip pains due to secondary arthrosis and walking ability impairment are frequent in ambulatory patients. The dislocation is the result of muscle imbalances in the hip region. The diagnosis is based on Illness history, clinical examination, neurological examination and radiography. Treatment is mostly operative, except in cases of pelvic symmetry and absence of difficulties. Pelvic and/or femoral osteotomy with or without open reduction of the hip is done in ambulatory patients with cerebral palsy. Soft-tissue surgery, hip flexors release and tenotomy of the hip adductors, are done in non-ambulatory patients with cerebral palsy. In patients with myelomeningocele soft-tissue surgery, hip flexors release and tractus iliotibialis resection on the lower side of the pelvis, are done regardless of the ability to walk. The same bone surgery procedures as in cerebral palsy are done only in ambulatory patients with unilateral dislocations if soft-tissue surgery failed.
青少年麻痹性髋关节脱位并不常见，但无论是在青少年期首次诊断，还是由于早期未治疗或治疗失败所致，都会引发严重问题。它是脑瘫和脊髓脊膜膨出的特征性表现。如果青少年麻痹性髋关节脱位不对称，就会出现骨盆倾斜、腿长不等、坐姿失衡、脊柱侧弯以及继发性脊椎病及其所有后果。在能行走的患者中，因继发性关节炎导致的髋关节疼痛和行走能力受损等并发症很常见。这种脱位是髋关节区域肌肉失衡的结果。诊断基于病史、临床检查、神经学检查和影像学检查。除骨盆对称且无困难的情况外，治疗大多采用手术方式。对于能行走的脑瘫患者，会进行骨盆和/或股骨截骨术，可伴有或不伴有髋关节切开复位。对于不能行走的脑瘫患者，会进行软组织手术、髋关节屈肌松解和髋关节内收肌切断术。对于脊髓脊膜膨出患者，无论其行走能力如何，都会进行软组织手术、髋关节屈肌松解和骨盆下侧的髂胫束切除术。只有在单侧脱位的能行走患者中，如果软组织手术失败，才会采用与脑瘫患者相同的骨外科手术程序。
