Song H R, Carroll N C
Department of Orthopaedic Surgery, Gyeong-Sang National University Hospital, Chinju, Korea.
J Pediatr Orthop. 1998 Jan-Feb;18(1):62-8.
We reviewed 39 children with cerebral palsy who had surgery for hip subluxation or dislocation. Of 55 treated hips, 31 had a varus derotation osteotomy alone, and 24 had a combination of varus derotation osteotomy and an acetabular procedure. There was no significant difference in the ages of the two groups. There was no difference in the preoperative acetabular indices of the two groups, but the average percentage of preoperative uncoverage of the femoral head was 56% in the group with varus derotation osteotomy and 63% in the group with combined varus derotation osteotomy with an acetabular procedure. The incidence of resubluxation or redislocation (24%) after varus derotation osteotomy alone was higher than that after varus derotation osteotomy with an acetabular procedure (13%). The incidence of postoperative hip instability was higher in the patients who had preoperative uncoverage of the femoral head ranging from 70 to 100%. This was in comparison with the patients who had preoperative uncoverage of the femoral head ranging from 30 to 70%. These results suggest that a combination of varus derotation osteotomy and an acetabular procedure decreases the incidence of resubluxation or redislocation, and that unstable hips with > 70% uncoverage of the femoral head should undergo the combined procedure.
我们回顾了39例因髋关节半脱位或脱位接受手术的脑瘫患儿。在55个接受治疗的髋关节中，31个仅接受了内翻旋转截骨术，24个接受了内翻旋转截骨术与髋臼手术的联合治疗。两组患儿的年龄无显著差异。两组术前髋臼指数无差异，但单纯内翻旋转截骨术组术前股骨头未覆盖的平均百分比为56%，内翻旋转截骨术与髋臼手术联合治疗组为63%。单纯内翻旋转截骨术后再半脱位或再脱位的发生率（24%）高于内翻旋转截骨术与髋臼手术联合治疗组（13%）。术前股骨头未覆盖范围在70%至100%的患者术后髋关节不稳定的发生率高于术前股骨头未覆盖范围在30%至70%的患者。这些结果表明，内翻旋转截骨术与髋臼手术联合治疗可降低再半脱位或再脱位的发生率，且股骨头未覆盖范围>70%的不稳定髋关节应接受联合手术。
