Sherk H H, Melchionne J, Smith R
Division of Orthopedics and Rehabilitation, Medical College of Pennsylvania, Philadelphia 19129.
Z Kinderchir. 1987 Dec;42 Suppl 1:48-9.
We studied 22 myelomeningocele patients with strong quadriceps and good ambulatory capability who had a dislocated hip. These patients did not have hip pain, had good to excellent hip motion and could sit with no difficulty. All but one was a good to excellent community ambulator with crutches and orthoses. Twenty-five percent had limb length inequality requiring shoe lifts but this combination did not impair functional capability. None owned wheelchairs. Seven had associated musculo-skeletal deformities which required treatment. We concluded that the hip dislocation in these patients was not significant. We evaluated a similar series of 11 patients who had open reduction of a dislocated hip an average of 18 months ago. Two patients were slightly improved and five patients were significantly worse after the open reductions. Serious complications related to the surgery ensued in half of the cases. The cost of the surgery and treatment of the complications in these 11 patients was $400,000. We concluded that surgical treatment of paralytic hip dislocations in ambulatory myelomeningocele patients offered no clear cut benefit.
我们研究了22例患有髓脊膜膨出且股四头肌有力、行走能力良好但髋关节脱位的患者。这些患者没有髋关节疼痛，髋关节活动良好至极佳，且能毫无困难地坐下。除一人外，其余患者使用拐杖和矫形器在社区行走能力良好至极佳。25%的患者存在肢体长度不等，需要使用增高鞋垫，但这种情况并未损害其功能能力。他们都没有轮椅。7例患者伴有需要治疗的肌肉骨骼畸形。我们得出结论，这些患者的髋关节脱位并不严重。我们评估了另一组11例患者，他们平均在18个月前接受了髋关节脱位切开复位术。切开复位术后，2例患者稍有改善，5例患者明显恶化。半数病例出现了与手术相关的严重并发症。这11例患者的手术及并发症治疗费用为40万美元。我们得出结论，对于能行走的髓脊膜膨出患者，麻痹性髋关节脱位的手术治疗并无明显益处。
