All India Institute of Medical Sciences, 251 Type III Quarters, Ayur Vigyan Nagar, August Kranti Marg, New Delhi 110049, India.
Arch Orthop Trauma Surg. 2011 Dec;131(12):1631-7. doi: 10.1007/s00402-011-1376-4. Epub 2011 Aug 19.
Hip reconstruction with subtrochanteric valgus extension pelvic support osteotomy and distal femoral osteotomy for lengthening and varus correction is one of the options available for salvage of chronic unstable hips and is also known as Ilizarov hip reconstruction (IHR). This study evaluated the outcomes and complications associated with IHR in skeletally mature young patients.
Twelve patients (7 males, 5 females) with a mean age of 23 years underwent IHR for chronically dislocated hips due to various causes. Preoperative clinical and radiological evaluations were used to determine the site of osteotomies and the required angulations. Postoperatively the patients were followed up clinically and radiologically for a minimum of 36 months. Ilizarov fixator was removed when adequate lengthening was achieved and there was radiological evidence of union. Harris Hip Score was used to document hip function preoperatively and at final evaluation.
Significant improvements occurred in limb length discrepancy (LLD) 5.11 cm preoperatively to 0.9 cm at final evaluation, Harris Hip Score 44.33 points preoperatively to 70.83 points (p < 0.0001) at final evaluation. Trendelenberg sign disappeared completely in nine patients and was delayed in three at final evaluation. The abduction at the hip increased from the preoperative mean of 12.08° (range 0°-25°) to 22.5° (range 15°-35°) postoperatively. The fixed flexion deformity at the hip decreased from 22° (range 10°-35°) preoperatively to 3° postoperatively (range 0°-10°). The amount of free flexion at the operated hips decreased from the preoperative mean of 88.33° (range 70°-120°) to 70.42° (range 45°-105°) at final follow up. The mean fixator interval was 7.33 months (5-12 months) and the mean follow up duration was 59.4 months (38-86 months).
IHR is effective in improving the hip biomechanics, correcting the LLD and eliminating the Trendelenberg sign. Lengthy period of fixator wear, knee stiffness and pin tract infections, though minor are known limitations of this procedure.
对于慢性不稳定髋关节，股骨转子下外展延长骨盆支撑截骨术和股骨远端截骨术进行髋关节重建是一种选择，也称为伊里扎洛夫髋关节重建（IHR）。本研究评估了在骨骼成熟的年轻患者中进行 IHR 的结果和相关并发症。
12 名患者（7 名男性，5 名女性），平均年龄 23 岁，因各种原因导致慢性髋关节脱位而接受 IHR。术前临床和影像学评估用于确定截骨部位和所需的角度。术后对患者进行至少 36 个月的临床和影像学随访。当达到足够的延长并出现影像学愈合证据时，取出伊里扎洛夫固定器。术前和最终评估时使用 Harris 髋关节评分记录髋关节功能。
术前肢体长度差异（LLD）为 5.11cm，最终评估时为 0.9cm，差异有统计学意义（p<0.0001）；术前 Harris 髋关节评分为 44.33 分，最终评估时为 70.83 分（p<0.0001）。最终评估时，9 例患者的 Trendelenberg 征完全消失，3 例延迟消失。髋关节外展从术前平均 12.08°（范围 0°-25°）增加到术后 22.5°（范围 15°-35°）。术前髋关节固定屈曲畸形从 22°（范围 10°-35°）减少到术后 3°（范围 0°-10°）。术后髋关节的自由屈曲程度从术前平均 88.33°（范围 70°-120°）减少到最终随访时的 70.42°（范围 45°-105°）。固定器间隔的平均时间为 7.33 个月（5-12 个月），平均随访时间为 59.4 个月（38-86 个月）。
IHR 可有效改善髋关节生物力学，纠正 LLD，并消除 Trendelenberg 征。虽然固定器佩戴时间长、膝关节僵硬和针道感染是该手术的已知局限性，但这些局限性较小。
