Choi I H, Pizzutillo P D, Bowen J R, Dragann R, Malhis T
Department of Medical Education, Alfred I. duPont Institute, Wilmington, Delaware 19899.
J Bone Joint Surg Am. 1990 Sep;72(8):1150-65.
We evaluated the residual deformity and late treatment of thirty-four hips of thirty-one children who had had septic arthritis when they were less than one year old. The hips were classified into four groups on the basis of radiographic changes. Type-I deformity (five hips) involved transient ischemia of the epiphysis, with or without mild coxa magna, and these hips did not need reconstruction. Type-II deformity (eleven hips) included deformity of the epiphysis, physis, and metaphysis, and these hips needed an operation to prevent subluxation; the goals of the operation included improvement in acetabular coverage, improvement in abductor efficiency by epiphyseodesis or transfer of the greater trochanter, and equalization of limb-length discrepancy by epiphyseodesis of the contralateral limb. Type-III deformity (five hips) involved malalignment of the femoral neck, with extreme anteversion or retroversion or with a pseudarthrosis of the femoral neck that necessitated a realignment osteotomy of the proximal part of the femur or bone-grafting of the pseudarthrosis. Type-IV deformity (thirteen hips) included destruction of the femoral head and neck, with persistence of only a remnant of the medial base of the femoral neck. In the hips that had a Type-IV deformity, the complex clinical problems, which included severe limb-length discrepancy and incompetent articulation of the hip, necessitated operations such as Pemberton osteotomy, trochanteric arthroplasty, arthrodesis, epiphyseodesis of the contralateral limb, and lengthening of the ipsilateral tibia. The functional result was satisfactory in all five hips that had a Type-I deformity, in seven of eleven that had a Type-II deformity, in three of four that had a Type-III deformity, and in only four of thirteen that had a Type-IV deformity.
我们评估了31名1岁前患过化脓性关节炎的儿童的34个髋关节的残余畸形及后期治疗情况。根据X线片变化，将髋关节分为四组。I型畸形（5个髋关节）包括骨骺短暂性缺血，伴或不伴有轻度髋增大，这些髋关节无需重建。II型畸形（11个髋关节）包括骨骺、骺板和干骺端畸形，这些髋关节需要手术以防止半脱位；手术目标包括改善髋臼覆盖、通过骨骺阻滞或大转子转移提高外展肌效率，以及通过对侧肢体骨骺阻滞平衡肢体长度差异。III型畸形（5个髋关节）包括股骨颈排列不齐，伴有极度前倾或后倾，或股骨颈假关节形成，这需要对股骨近端进行截骨矫形或对假关节进行植骨。IV型畸形（13个髋关节）包括股骨头和颈的破坏，仅残留股骨颈内侧基底部。对于IV型畸形的髋关节，复杂的临床问题包括严重的肢体长度差异和髋关节活动障碍，需要进行诸如Pemberton截骨术、转子间关节成形术、关节融合术、对侧肢体骨骺阻滞以及同侧胫骨延长等手术。I型畸形的所有5个髋关节、II型畸形的11个中的7个、III型畸形的4个中的3个以及IV型畸形的13个中的仅4个，功能结果令人满意。
