Nicodemo Alberto, Arrigoni Chiara, Bersano Andrea, Massè Alessandro
San Luigi Hospital, Department of Orthopedics and Traumatology, University of Turin Medical School, 10043 Orbassano, Italy.
Case Rep Med. 2014;2014:349014. doi: 10.1155/2014/349014. Epub 2014 Feb 12.
Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.
先天性、创伤性或外部原因可导致人们截瘫；其中一些情况可能是可逆的，而另一些则不可逆转。截瘫会导致髋关节屈曲挛缩，进而引发压疮、脊柱侧弯和腰椎前凸；腰部和腹股沟疼痛密切相关。科学文献中有许多关于儿童因神经疾病导致髋关节屈曲的研究，主要由脑瘫引起；仅有少数论文关注成人的这种并发症。在本研究中，我们报告了对因神经疾病导致的成人髋关节屈曲挛缩进行手术治疗的经验；我们试图勾勒出一种算法，以选择最佳治疗方法，避免无用或过度激进的治疗。我们展示了5例按照我们的算法治疗的因神经疾病导致的成人髋关节屈曲病例。在1年的随访中，所有患者在髋关节活动范围、疼痛以及尽可能恢复行走方面均取得了良好的临床效果。总之，我们认为即使我们需要治疗更多患者来证实这一理论，该算法也可能是治疗这些复杂病例的良好指导方针。我们还认为术后物理治疗对于保持髋关节活动度、改善肌肉功能以及尽可能恢复行走能力是有用的。
