From the Department of Orthopaedic Surgery (Dr. Shaw), Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, the Department of Orthopaedic Surgery (Dr. Shaw and Dr. Cearley), Children's Hospital of Georgia at Augusta University, Augusta, GA, and the Department of Orthopaedic Surgery (Dr. Hire), General Leonard Wood Army Community Hospital, Fort Leonard Wood, MO.
J Am Acad Orthop Surg. 2020 May 1;28(9):363-375. doi: 10.5435/JAAOS-D-19-00349.
Hip dislocation is a common occurrence in nonambulatory patients with cerebral palsy, occurring in up to 70% of patients. However, only 15% to 57% of chronic dislocations progress to become painful. In these patients, several salvage treatment options are available, including proximal femoral resection, subtrochanteric valgus osteotomy, hip arthrodesis, and prosthetic arthroplasty. Of the options, proximal femoral resection, subtrochanteric osteotomy, and prosthetic arthroplasty have been shown to provide reliable pain relief with improved sitting balance, with no evidence of one technique being superior to another. However, each technique has unique aspects to its postoperative care and potential complication profile that requires thorough understanding and communication with parents/caregivers when considering surgical intervention.
髋关节脱位在脑瘫非卧床患者中很常见，发生率高达 70%。然而，只有 15%至 57%的慢性脱位会发展为疼痛。对于这些患者，有几种挽救性治疗选择，包括股骨近端切除术、转子下内翻截骨术、髋关节融合术和人工关节置换术。在这些选择中，股骨近端切除术、转子下截骨术和人工关节置换术已被证明可提供可靠的疼痛缓解，并改善坐姿平衡，没有证据表明一种技术优于另一种技术。然而，每种技术的术后护理和潜在并发症特征都有其独特之处，在考虑手术干预时需要与家长/照顾者进行充分的沟通和理解。
