Parent H F, Mascard E, Zeller R, Seringe R
Hôpital Saint Vincent de Paul, Paris.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(4):346-50.
Severe valgus deformity of the upper femur is a frequent feature of the unstable paralytic hip. Thus, the insertion of the osteosynthesis material during a varization osteotomy can be technical demanding. Risks and benefits of a modified femoral varization osteotomy were evaluated in a retrospective follow-up study.
53 paralytic hips (33 patients) have been operated from September 1989 to april 1993. Mean age at surgery was 6 years. The etiologies were Spinal Amyotrophy in 12 hips, Cerebral Palsy in 31 hips and miscellaneous neurologic diseases in 10 hips. The average neck-shaft angle before surgery was 162 degrees. The mean Reimers' Index was 58 per cent.
The upper femoral shaft was exposed by subperiosteal dissection in a circumferential manner. An intertrochanteric osteotomy was carried out. The direction of the femoral neck was identified. An AO 100 degree blade plate was then introduced under direct visual control through the cancellous osteotomy surface of the proximal fragment. Radiological and clinical outcome were assessed at last follow-up. Mean follow-up was 16 months.
Solid fusion was obtained in all patients. The mean postoperative neck-shaft angle was 104 degrees. The mean Reimers' Index was 17 per cent at last follow-up. Two infections were noted. Voluminous calcifications under the femoral neck have been observed in 6 cases. Recurrence of the valgus deformity was noted in 9 hips at last follow-up.
This simplified varization technique permits a large amount of varization. The medialization diminishes the problem of protruding hardware. The complications rate appears to be low without any femoral head necrosis in this series despite subperiosteal dissection of the femoral neck.
The authors think that this modified varization technique may deserve consideration in the treatment of the unstable paralytic hip.
股骨上段严重外翻畸形是不稳定麻痹性髋关节的常见特征。因此，在股骨内翻截骨术中植入骨合成材料可能对技术要求较高。在一项回顾性随访研究中评估了改良股骨内翻截骨术的风险和益处。
1989年9月至1993年4月期间，对53例麻痹性髋关节（33例患者）进行了手术。手术时的平均年龄为6岁。病因包括12例脊髓性肌萎缩症、31例脑性瘫痪和10例其他神经系统疾病。术前平均颈干角为162度。平均赖默斯指数为58%。
通过骨膜下环形剥离暴露股骨上段。进行转子间截骨术。确定股骨颈的方向。然后在直视控制下，通过近端骨折块的松质骨截骨面插入一块AO 100度的接骨板。在最后一次随访时评估放射学和临床结果。平均随访时间为16个月。
所有患者均实现牢固融合。术后平均颈干角为104度。最后一次随访时平均赖默斯指数为17%。记录到2例感染。6例患者观察到股骨颈下方有大量钙化。最后一次随访时，9例髋关节出现外翻畸形复发。
这种简化的内翻技术允许进行大量内翻。内移减少了植入物突出的问题。尽管对股骨颈进行了骨膜下剥离，但该系列中的并发症发生率似乎较低，且未出现任何股骨头坏死。
作者认为，这种改良的内翻技术在治疗不稳定麻痹性髋关节时可能值得考虑。
