Xu Amy L, Dean Janet M, Margalit Adam, Sponseller Paul D, Sadowsky Cristina L
Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Orthop Case Rep. 2022 Nov;12(11):34-37. doi: 10.13107/jocr.2022.v12.i11.3404.
Acute flaccid myelitis (AFM) is a recently described diagnosis that primarily impacts the pediatric population. It is characterized by profound proximal muscle weakness with resultant orthopedic manifestations similar to well-known neuromuscular conditions. While the incidence of AFM has been rising, management outcomes are understudied. Here, we describe the first known case of hip reconstruction in AFM.
A 5-year-old female presented with painful bilateral hip subluxations 2 years after being diagnosed with AFM. Imaging confirmed substantial uncovering of the femoral heads, right greater than left, with reduction on abduction views. Given the extent of her hip pathology and symptoms, she underwent bilateral Dega and varus derotational osteotomies with adductor lengthening, achieving a 35° correction in femoral neck angle and 30° reduction in femoral anteversion bilaterally. At 2 years postoperatively, she was asymptomatic without recurrence of hip displacement.
Reconstructive femoral osteotomies can be effective for achieving painless, reduced hips in patients with AFM. Thus, surgeons may reasonably extrapolate current concepts utilized for other low-tone neuromuscular conditions to inform approach to AFM.
急性弛缓性脊髓炎（AFM）是一种最近才被描述的疾病诊断，主要影响儿童群体。其特征为严重的近端肌肉无力，并伴有与知名神经肌肉疾病相似的骨科表现。虽然AFM的发病率一直在上升，但对其治疗效果的研究却很少。在此，我们描述了首例AFM患者进行髋关节重建的病例。
一名5岁女性在被诊断为AFM两年后出现双侧髋关节半脱位疼痛。影像学检查证实股骨头大量外露，右侧比左侧更严重，外展视图显示有复位情况。鉴于其髋关节病变的程度和症状，她接受了双侧德加截骨术和内翻旋转截骨术并延长内收肌，双侧股骨颈角度矫正35°，股骨前倾角减小30°。术后2年，她无症状，髋关节无复发移位。
重建性股骨截骨术对于实现AFM患者无痛、复位的髋关节可能是有效的。因此，外科医生可以合理地借鉴目前用于其他低张力神经肌肉疾病的概念来指导对AFM的治疗。
