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优化脑瘫相关痉挛性髋关节发育不良的髋关节置换手术:一例报告

Optimizing Hip Replacement Procedure in Cerebral Palsy-Related Spastic Hip Dysplasia: A Case Report.

作者信息

Drakou Androniki, Altsitzioglou Pavlos, Sioutis Spyridon, Roustemis Anastasios G, Mastrokalos Dimitrios S, Koulalis Dimitrios

机构信息

Department of Orthopaedic Surgery, Laiko University Hospital, Athens, GRC.

1st Department of Orthopaedic Surgery, Attikon University Hospital, Athens, GRC.

出版信息

Cureus. 2024 Apr 4;16(4):e57584. doi: 10.7759/cureus.57584. eCollection 2024 Apr.

Abstract

Cerebral palsy (CP) often results in severe hip issues, disrupting musculoskeletal development and mobility due to problems such as dislocations and contractures, aggravated by spasticity and heightened muscular tone. While total hip arthroplasty (THA) is required in CP patients, the procedure carries high risks due to concerns about dislocation and wear. This study explores a method of intraoperative navigation to precisely execute preoperative strategies for spinopelvic alignment and optimal cup placement. We discuss a case of a 22-year-old male CP patient with bilateral hip dislocations who experienced significant discomfort, impeding mobility and affecting his performance as a Paralympic rower. He underwent bilateral hip replacement surgeries, guided by preoperative gait analysis and imaging, with navigation aiding in accurate acetabular component placement and correction of excessive femoral anteversion using a modular stem. The patient achieved excellent stability in both standing and rowing postures. Overall, computer navigation enhances complex hip repair by facilitating intraoperative data collection and precise execution of preoperative plans. This approach may extend the lifespan of prostheses, particularly by achieving precise acetabular component placement based on spinopelvic alignment principles, thereby offering significant benefits for CP patients undergoing THA.

摘要

脑瘫(CP)常导致严重的髋关节问题,由于脱位和挛缩等问题破坏肌肉骨骼发育和活动能力,痉挛和肌张力增加会使情况恶化。虽然CP患者需要进行全髋关节置换术(THA),但由于担心脱位和磨损,该手术风险很高。本研究探索一种术中导航方法,以精确执行术前关于脊柱骨盆对线和最佳髋臼放置的策略。我们讨论了一例22岁男性CP患者,双侧髋关节脱位,经历了严重不适,妨碍了活动能力,并影响了他作为残奥会赛艇运动员的表现。他在术前步态分析和成像的指导下接受了双侧髋关节置换手术,导航辅助准确放置髋臼组件,并使用模块化柄纠正股骨过度前倾。患者在站立和赛艇姿势下均获得了出色的稳定性。总体而言,计算机导航通过促进术中数据收集和精确执行术前计划,增强了复杂的髋关节修复。这种方法可能会延长假体的使用寿命,特别是通过基于脊柱骨盆对线原则实现精确的髋臼组件放置,从而为接受THA的CP患者带来显著益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e025/11069124/0486d3e2c405/cureus-0016-00000057584-i01.jpg

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