Rocha Luis Eduardo Munhoz da, Nishimori Fábio Koiti, Figueiredo Daniel Carvalho de, Grimm Dulce Helena, Cunha Luiz Antonio Munhoz da
Orthopedist at Hospital Pequeno Príncipe (HPP), Curitiba, PR, Brazil.
Resident in Orthopedics and Traumatology, Hospital Pequeno Príncipe (HPP), Curitiba, PR, Brazil.
Rev Bras Ortop. 2015 Dec 12;45(5):403-8. doi: 10.1016/S2255-4971(15)30427-4. eCollection 2010 Sep-Oct.
To evaluate the results from surgical treatment of hip dislocation through the anteromedial approach, in patients with arthrogryposis multiplex congenita (AMC).
The medical files and radiographs of seven children with AMC who presented hip dislocation (total of 10 dislocated hips) were retrospectively reviewed. Pre and postoperative joint mobility was evaluated by summing the joint range of motion in flexion and abduction. The acetabular angle and height of the femoral neck before the operation, and the continuity of the Shenton arc, Sharp angle and center-edge (CE) angle after the operation, were evaluated radiographically. When avascular necrosis was identified, it was classified in accordance with Ogden and Bucholz.
The mean age of the children at the time of the surgery was 5.5 months (range: 3 to 11 months). The mean duration of follow-up for the patients was 9.5 years (range: 2 to 13 years). The mean amplitude of the sum of the joint range of motion in flexion and abduction in the preoperative examination was 108° (range: 70° to 155°) and postoperatively, it was 125° (range: 75° to 175°). In the last evaluation, eight hips were found to be centered and two were subluxated. Two hips had been subjected to Salter iliac osteotomy. Two hips (20%) had presented significant signs of Ogden type IV avascular necrosis. Eight hips had good results while two were fair.
We consider that the anteromedial approach is a good option for treating hip dislocation in very young patients with arthrogryposis multiplex congenita.
评估先天性多发性关节挛缩症（AMC）患者经前内侧入路手术治疗髋关节脱位的结果。
回顾性分析7例患有AMC且出现髋关节脱位（共10个脱位髋关节）患儿的病历和X线片。术前和术后通过将屈曲和外展的关节活动范围相加来评估关节活动度。术前评估髋臼角和股骨颈高度，术后评估Shenton线的连续性、Sharp角和中心边缘（CE）角。当发现缺血性坏死时，按照Ogden和Bucholz的方法进行分类。
患儿手术时的平均年龄为5.5个月（范围：3至11个月）。患者的平均随访时间为9.5年（范围：2至13年）。术前检查中屈曲和外展关节活动范围总和的平均幅度为108°（范围：70°至155°），术后为125°（范围：75°至175°）。在最后一次评估中，发现8个髋关节复位，2个半脱位。2个髋关节接受了Salter髂骨截骨术。2个髋关节（20%）出现了明显的Ogden IV型缺血性坏死体征。8个髋关节效果良好，2个一般。
我们认为前内侧入路是治疗先天性多发性关节挛缩症非常年幼患者髋关节脱位的一个好选择。
