Neitzke Colin, Gusho Charles, Yu Austin, Williams Joel
Department of Orthopedic Surgery, Hospital for Special Surgery, City New York, New York.
Chicago Medical School, North Chicago, Illinois.
J Orthop Case Rep. 2024 May;14(5):78-82. doi: 10.13107/jocr.2024.v14.i05.4440.
Spina bifida is a rare neurological condition that, if uncorrected, may cause chronic valgus knee stress difficulty with independent ambulation and significant pain. Current literature lacks comprehensive guidance on surgically correcting progressive hip and knee deformities in spina bifida patients, which include osteotomy and primary. When these options are contraindicated, alternative approaches such as arthrodesis may be indicated, although they remain understudied in this population.
A 47-year-old man presented with bilateral hip and knee pain. Radiographs demonstrated valgus knee deformities with severe arthrosis and bilateral femoral head subluxation. The patient had a history of spina bifida with chronic lower extremity weakness and neurogenic bladder. He underwent staged bilateral instrumented knee arthrodesis and staged bilateral total hip arthroplasty (THA).
This is the first reported case of bilateral instrumented knee arthrodesis in a patient with spina bifida. Orthopedic care of these patients is complex. Surgical correction of symptomatic knee and hip deformities through instrumented arthrodesis and THA may permit an improved functional outcome.
脊柱裂是一种罕见的神经系统疾病，如果不加以矫正，可能会导致慢性膝外翻应力，影响独立行走并引起严重疼痛。目前的文献缺乏关于手术矫正脊柱裂患者进行性髋部和膝部畸形的全面指导，这些畸形包括截骨术和初次手术。当这些选择存在禁忌时，可能需要采用诸如关节融合术等替代方法，尽管在这一人群中对其研究仍然不足。
一名47岁男性因双侧髋部和膝部疼痛就诊。X线片显示膝外翻畸形伴严重关节炎和双侧股骨头半脱位。该患者有脊柱裂病史，伴有慢性下肢无力和神经源性膀胱。他接受了分期双侧器械辅助膝关节融合术和分期双侧全髋关节置换术（THA）。
这是首例报道的脊柱裂患者接受双侧器械辅助膝关节融合术的病例。这些患者的骨科护理较为复杂。通过器械辅助关节融合术和全髋关节置换术对有症状的膝部和髋部畸形进行手术矫正，可能会改善功能结局。
