Kantor R, Salai M, Ganel A
Sheba Medical Center, Tel-Hashomer, Israel.
Clin Orthop Relat Res. 1997 Feb(335):240-5.
This study evaluates long term orthopaedic aspects of children with bladder exstrophy who were operated on using different techniques and at different ages. Data were accumulated from 20 patients with an age range of 2 to 29 years (average, 13 years). Fourteen patients underwent pelvic osteotomy. Interviews and physical examinations confirmed that, in the long term, children with classical bladder exstrophy do not have significant orthopaedic problems or disability, whether or not they underwent pelvic osteotomy. Radiographic imaging showed normal hip joint configuration with marked pubic diastasis. There were no clinical problems associated with the diastasis. Pelvic computed tomography studies in 7 patients showed marked remodeling of the femora and acetabula. Radiographs of the spine showed a curve in 7 (47%) of the patients, but in only 3 cases was the curve larger than 10 degrees. Pelvic osteotomy is indicated during surgical correction of bladder exstrophy to facilitate closure of the abdominal wall to prevent postoperative wound dehiscence and possibly achieve better urinary control in older age. However, there is no clear indication for pelvic osteotomy from an orthopaedic point of view.
本研究评估了采用不同技术和在不同年龄接受手术的膀胱外翻患儿的长期骨科情况。数据来自20例年龄在2至29岁（平均13岁）的患者。14例患者接受了骨盆截骨术。访谈和体格检查证实，从长期来看，经典膀胱外翻患儿无论是否接受骨盆截骨术，均无明显的骨科问题或残疾。影像学检查显示髋关节结构正常，但耻骨分离明显。耻骨分离未伴有临床问题。7例患者的骨盆计算机断层扫描研究显示股骨和髋臼有明显重塑。脊柱X线片显示7例（47%）患者有脊柱侧弯，但只有3例侧弯大于10度。在膀胱外翻手术矫正过程中进行骨盆截骨术，有助于关闭腹壁，防止术后伤口裂开，并可能在年长时实现更好的尿控。然而，从骨科角度来看，骨盆截骨术并无明确指征。
