Sutherland D, Pike L, Kaufman K, Mowery C, Kaplan G, Romanus B
University of California, San Diego.
J Pediatr Orthop. 1994 Nov-Dec;14(6):709-14. doi: 10.1097/01241398-199414060-00004.
Patients with bladder exstrophy demonstrate pubic diastasis with external rotation of the ilia and posterolateral orientation of the acetabula. Iliac osteotomy is performed to approximate the pubis and thus facilitate the genitourinary repair. The role of iliac osteotomy in the correction of gait abnormalities is controversial. Our goals in this study were to define the presence of hip pathology and gait abnormalities in patients treated for bladder exstrophy and to evaluate the effect of iliac osteotomy. We reviewed pelvic radiographs and gait studies in 15 children. The treatment included bilateral iliac osteotomy in nine of 15 of these patients. We found minor hip dysplasia in two patients, but we saw no evidence of subluxation or dislocation. Pubic diastasis increased with age and was not related to osteotomy. Patients had slightly less passive hip internal rotation than age-matched controls. There was no correlation between the restriction of hip internal rotation and the amount of pubic diastasis. Two thirds (10 of 15) of the patients exhibited increased lower extremity external rotation during gait. None of the subjects demonstrated a waddling gait (gluteus medius lurch) described in the literature. Based on our results, iliac osteotomy does not affect gait patterns in children with bladder exstrophy. However, we believe that it is indicated to improve the results of genitourinary repair.
膀胱外翻患者表现为耻骨分离，伴有髂骨外旋和髋臼后外侧移位。进行髂骨截骨术以拉近耻骨，从而便于进行泌尿生殖系统修复。髂骨截骨术在纠正步态异常方面的作用存在争议。我们在本研究中的目标是确定接受膀胱外翻治疗的患者中髋关节病变和步态异常的存在情况，并评估髂骨截骨术的效果。我们回顾了15名儿童的骨盆X线片和步态研究。其中15名患者中有9名接受了双侧髂骨截骨术治疗。我们在两名患者中发现了轻度髋关节发育不良，但未发现半脱位或脱位的证据。耻骨分离随年龄增加，与截骨术无关。患者的髋关节被动内旋略少于年龄匹配的对照组。髋关节内旋受限与耻骨分离程度之间无相关性。三分之二（15名中的10名）患者在步态中表现出下肢外旋增加。没有受试者表现出文献中描述的摇摆步态（臀中肌跛行）。根据我们的结果，髂骨截骨术不会影响膀胱外翻患儿的步态模式。然而，我们认为它有助于改善泌尿生殖系统修复的效果。
