Gennari J M, Merrot T, Piclet-Legre B, Bergoin M
Service de Chirurgie infantile et Orthopédique, CHU Nord, Marseille.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(8):702-08.
The aim of this study was to relate the efficacy of cutting the psoas tendon in case of high congenital hip dislocation treated by slow reduction according to Somerville-Petit.
Twenty psoas tenotomies were realised between 1982 and 1992. The average age was 11 months 15 days old, they were 15 girls and 5 boys. Among them, only 9 patients had never been treated.
By a short surgical approach close to the lateral lip of Scarpa's triangle, we cut the psoas tendon at the musculotendinous junction doing this suppresses the obstacle that interferes with the femoral head coming down.
Results have been evaluated on clinically and especially radiologically. All hips remain stable except one case. A graduated subluxation of the hip occured after removal of the plaster. 18 hips have been revised between the third and fifth year. Clinical results were excellent, on radiological controls 5 hips were considered flawless, 11 satisfying, and 2 were imperfect. Only 2 children have been seen ten years later with excellent clinical and radiological results.
The hypertrophic psoas tendon interposes between the femoral head and the acetabulum creasing the capsule and the limbus. Cutting tendon of the psoas will decrease the numerous unexplained failures that occured during slow reduction according to Sommerville-Petit method. The use of these surgical techniques may make more outstanding the tenotomies time.
Tenotomy of the psoas tendon realized by a short surgical approach without any articular effraction, allowed us to obtain complete reduction of the hips dislocation in these 20 patients.
本研究的目的是探讨在采用Somerville - Petit缓慢复位法治疗高位先天性髋关节脱位时，切断腰大肌肌腱的疗效。
1982年至1992年间共进行了20例腰大肌肌腱切断术。平均年龄为11个月15天，其中女孩15例，男孩5例。其中，只有9例患者从未接受过治疗。
通过靠近斯卡帕三角外侧缘的短手术入路，在肌腱肌肉交界处切断腰大肌肌腱，这样可以消除干扰股骨头下降的障碍。
通过临床评估，尤其是影像学评估。除1例病例外，所有髋关节均保持稳定。拆除石膏后出现了髋关节的渐进性半脱位。在第三年至第五年期间，对18个髋关节进行了翻修。临床结果良好，在影像学检查中，5个髋关节被认为完美，11个令人满意，2个不理想。10年后仅2名儿童的临床和影像学结果良好。
肥厚的腰大肌肌腱介于股骨头和髋臼之间，使关节囊和髋臼唇皱缩。切断腰大肌肌腱将减少根据Sommerville - Petit方法在缓慢复位过程中发生的许多不明原因的失败。这些手术技术的应用可能会使肌腱切断术的时机更加突出。
通过短手术入路进行腰大肌肌腱切断术，且无任何关节损伤，使我们在这20例患者中实现了髋关节脱位的完全复位。
