Đapić Tomislav, Kubat Ozren
Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
Acta Clin Croat. 2023 Aug;62(Suppl3):25-29. doi: 10.20471/acc.2023.62.s3.3.
Cerebral palsy often carries a high risk of hip involvement, especially in patients with a higher degree of body involvement. Hip subluxations and dislocations are commonly seen in non-ambulatory patients. We report on a single skin incision anterolateral approach to the hip that provides excellent visualisation of all relevant anatomical structures and allows for a broad range of operative procedures needed to complete the San Diego operation. From 2005 to 2020, 50 patients (56 hips) were treated using the San Diego procedure. There were 22 male and 28 female patients, with 28 dislocated and 28 subluxated hips. The average patient age at the time of surgery was nine (range, 4 - 22 years). A San Diego or Dega pelvic osteotomy was done in 49 hips, and seven hips underwent a Brunner-type pelvic osteotomy. The mean follow-up was seven years (range, 2 - 13 years). The median preoperative AI measured at 40° (range, 35° - 50°). The median postoperative AI at the time of the most recent follow-up was 22,5° (range, 5° - 40°). The average head migration index at the last follow-up was 10% (range, 0% - 60%). Two infections, three recurring adduction contractures, four redislocations, one fracture, and one pseudarthrosis were encountered. All patients were eventually able to sit pain-free, with significantly better sitting balance.
脑瘫常伴有较高的髋关节受累风险，尤其是身体受累程度较高的患者。髋关节半脱位和脱位在非行走患者中很常见。我们报告一种单一皮肤切口的髋关节前外侧入路，该入路能很好地显示所有相关解剖结构，并允许进行完成圣地亚哥手术所需的广泛手术操作。2005年至2020年，50例患者（56髋）接受了圣地亚哥手术治疗。男性22例，女性28例，脱位髋28例，半脱位髋28例。手术时患者的平均年龄为9岁（范围4 - 22岁）。49髋进行了圣地亚哥或德加骨盆截骨术，7髋进行了布伦纳型骨盆截骨术。平均随访7年（范围2 - 13年）。术前平均髋臼指数（AI）为40°（范围35° - 50°）。最近一次随访时术后AI中位数为22.5°（范围5° - 40°）。最后一次随访时平均股骨头移位指数为10%（范围0% - 60%）。出现2例感染、3例复发性内收挛缩、4例再脱位、1例骨折和1例假关节。所有患者最终都能无痛坐立，坐位平衡明显改善。
