Root L, Laplaza F J, Brourman S N, Angel D H
Hospital for Special Surgery, New York, N.Y. 10021, USA.
J Bone Joint Surg Am. 1995 May;77(5):703-12. doi: 10.2106/00004623-199505000-00006.
The results in thirty-one patients with cerebral palsy who had a total of thirty-five severely subluxated or dislocated hips were analyzed retrospectively a mean of seven years after open reduction, pelvic osteotomy, varus rotational osteotomy, and femoral shortening. Preoperatively, twenty-two patients had been unable to stand and thirteen had had pain; the mean acetabular index was 50 degrees, the mean center-edge angle was -19 degrees, and the mean migration index was 74 percent. At the latest follow-up examination, none of the hips were painful. Seven patients had an improvement of one level in their walking ability. All of the patients who were confined to a wheelchair had better sitting balance. The mean acetabular index was 40 degrees, the mean center-edge angle was 18 degrees, and the mean migration index was 25 percent. Four hips were subluxated (two of them posteriorly). One hip was treated with a repeat varus rotational osteotomy. Another hip, which was not dislocated, had a rotational osteotomy for excessive femoral anteversion. Eight femoral heads displayed signs of avascular necrosis. One tibial and two femoral fractures occurred after the cast was removed. Three of the four patients who had a subluxated hip had scoliosis. The combined approach improved coverage of the femoral head and decreased pain in the hip. Even though this procedure can be accompanied by serious complications, we believe that the results justify this extensive approach in these patients.
对31例患有脑瘫且共有35个严重半脱位或脱位髋关节的患者进行回顾性分析，这些患者在接受切开复位、骨盆截骨术、内翻旋转截骨术和股骨缩短术后平均随访了7年。术前，22例患者无法站立，13例有疼痛；平均髋臼指数为50度，平均中心边缘角为-19度，平均移位指数为74%。在最近的随访检查中，所有髋关节均无疼痛。7例患者的行走能力提高了一级。所有只能坐轮椅的患者坐位平衡都有所改善。平均髋臼指数为40度，平均中心边缘角为18度，平均移位指数为25%。有4个髋关节半脱位（其中2个为后脱位）。1个髋关节接受了再次内翻旋转截骨术治疗。另一个未脱位的髋关节因股骨前倾过大接受了旋转截骨术。8个股骨头出现缺血性坏死迹象。拆除石膏后发生1例胫骨骨折和2例股骨骨折。4例髋关节半脱位患者中有3例患有脊柱侧弯。联合手术方法改善了股骨头的覆盖并减轻了髋关节疼痛。尽管该手术可能伴有严重并发症，但我们认为这些结果证明了对这些患者采用这种广泛手术方法的合理性。
