Benaroch T E, Richards B S, Haideri N, Smith C
Montreal Children's Hospital, Department of Orthopaedic Surgery, Quebec, Canada.
J Pediatr Orthop. 1996 Jan-Feb;16(1):30-6. doi: 10.1097/00004694-199601000-00007.
Thirteen male patients (average age, 15.6 years) underwent intraarticular hip arthrodesis for unilateral disabling hip disease. Follow-up averaged 6.6 years. Seven patients had excellent or good Harris hip scores. Ten patients had low back pain, and seven patients had knee pain on the side of the fused hip. Limb-length discrepancy averaged 3.7 cm. A progressive hip adduction drift (average, 7 degrees) occurred during follow-up. Patients whose hips were fused in a position of 20-25 degrees flexion and whose limb-length discrepancies were < 2 cm had significantly lower incidences of back pain. Cybex muscle testing revealed significantly decreased quadriceps strength (29%) on the hip-fusion side. Gait laboratory analysis demonstrated decreased velocity, stride length, and cadence. There were two mildly symptomatic nonunions. Based on these results, we recommend that the hip fusion be positioned in 20 degrees flexion and 0 degree abduction. The joint must be completely debrided down to viable bone to maximize chances for union. Maintaining a limb-length discrepancy of < 2 cm is essential to minimize the incidence of low back pain, quadriceps deficiency, and abnormal gait parameters.
13名男性患者（平均年龄15.6岁）因单侧致残性髋关节疾病接受了髋关节内固定术。随访平均6.6年。7名患者的Harris髋关节评分优良。10名患者有腰痛，7名患者在融合髋关节侧有膝关节疼痛。肢体长度差异平均为3.7厘米。随访期间出现了渐进性髋关节内收漂移（平均7度）。髋关节融合于屈曲20 - 25度且肢体长度差异<2厘米的患者腰痛发生率显著较低。Cybex肌肉测试显示髋关节融合侧股四头肌力量显著下降（29%）。步态实验室分析显示速度、步长和步频降低。有2例轻度症状性骨不连。基于这些结果，我们建议将髋关节融合置于屈曲20度和外展0度的位置。关节必须彻底清创至有活力的骨面，以最大化愈合机会。保持肢体长度差异<2厘米对于将腰痛、股四头肌功能不足和异常步态参数的发生率降至最低至关重要。
