Selva G, Miller F, Dabney K W
Department of Orthopaedics, Alfred I. duPont Institute, Wilmington, Delaware, USA.
J Pediatr Orthop. 1998 Jan-Feb;18(1):54-61.
This is a report of 27 hips with anterior dislocation in 17 children with cerebral palsy. Type 1 consists of patients with extension-external rotation and adduction contracture of the hip and extension contracture of the knee; type 2 consists of patients with extension-external rotation and abduction contracture of the hip and flexion contracture of the knee; and type 3 consists of patients without contractures. All children with types 1 and 2 were unable to sit and were forced into an almost full-time lying position. No child with type 3 pattern had sitting troubles. Hip pain was present in 50% of patients. All children with type 1 pattern and half of children with types 2 and 3 developed a thoracolumbar kyphosis. Standard radiographic hip measurements were inconsistent, and only three-dimensional computed tomography scans were useful in fully assessing the deformity. Indications for hip surgery were inability to sit or hip pain or both. Reconstruction was performed by anterior superior acetabular reconstruction and varus-shortening femoral osteotomy or proximal femur resection as a salvage procedure. Although three of the 13 children required two procedures, 11 of 13 children who underwent 16 hip procedures had stable and painless hips at the time of follow-up.
这是一份关于17例脑瘫患儿中27个髋关节前脱位的报告。1型包括髋关节存在伸展-外旋和内收挛缩以及膝关节伸展挛缩的患者；2型包括髋关节存在伸展-外旋和外展挛缩以及膝关节屈曲挛缩的患者；3型包括没有挛缩的患者。所有1型和2型患儿都无法坐立，几乎被迫全天处于卧位。3型模式的患儿没有坐立困难。50%的患者存在髋关节疼痛。所有1型模式的患儿以及2型和3型模式患儿中的一半出现了胸腰段脊柱后凸。标准的髋关节X线测量结果不一致，只有三维计算机断层扫描有助于全面评估畸形情况。髋关节手术的指征是无法坐立或髋关节疼痛或两者皆有。通过髋臼前上重建和内翻-缩短股骨截骨术或近端股骨切除术进行重建作为挽救手术。虽然13名患儿中有3名需要进行两次手术，但在接受16例髋关节手术的13名患儿中，有11名在随访时髋关节稳定且无痛。
