Arlaud J Y, Legré G, Aubaniac J M
Centre Borély, Marseille.
Rev Chir Orthop Reparatrice Appar Mot. 1990;76(6):411-9.
The authors have realized this surgical procedure upon 68 patients from 1978 to 1987. The fusion was badly tolerated or initiated a decompensation in the lumbar spine, in the knees, or in the opposite hip. This type of arthroplasty is difficult because the usual anatomical marks are changed and a pre-operative schedule is necessary to restore a satisfactory abductor strength. Special implants are needed to fit the frequent femoral dystrophies. 57 patients (62 hips) have been reviewed four to five years after operation. The functional improvement was important in the lumbar spine, not as much in the knees and in the opposite hip. The result upon the operated hip was satisfying for the mobility (average flexion: 78 degrees) and for the pain which disappeared apart from scarce complications. But, the stability was not as good with 20 per cent insufficiencies of the gluteus medius, implying for these patients the use of a walking-stick, the impossibility of standing on one leg, and the Trendelenburg sign. The state of the gluteus medius is the condition of a successful operation. The electromyogram performed before the operation may show a denervation; in this case, a choice must be done between an osteotomy of femoral correction and an arthroplasty implying a risk of instability which would be said to the patient.
1978年至1987年期间，作者对68例患者实施了该手术。腰椎、膝关节或对侧髋关节对融合的耐受性较差，或引发了失代偿。这种类型的关节成形术很困难，因为通常的解剖标志发生了改变，需要术前计划来恢复令人满意的外展肌力量。需要特殊的植入物来适应常见的股骨萎缩。57例患者（62髋）在术后四到五年接受了复查。腰椎的功能改善显著，而膝关节和对侧髋关节的改善则不那么明显。手术髋关节的活动度（平均屈曲度：78度）和疼痛情况令人满意，除了少数并发症外疼痛消失。但是，臀中肌功能不全发生率为20%，稳定性不佳，这意味着这些患者需要使用拐杖，无法单腿站立，且存在臀中肌步态。臀中肌的状态是手术成功的条件。术前进行的肌电图检查可能显示神经失用；在这种情况下，必须在股骨矫正截骨术和存在不稳定风险的关节成形术之间做出选择，并告知患者相关风险。
