Brunner R
Division of Pediatric Orthopedics, University of Basel, Switzerland.
Acta Orthop Belg. 1998 Mar;64(1):7-16.
A retrospective study of the surgical repair of dislocated or subluxed hip joints in patients with spastic cerebral palsy was carried out to determine the procedure with the lowest recurrence rate. An open reduction and a corrective femoral osteotomy were combined with different pelvic osteotomies and different interventions on the iliopsoas muscle in most cases. The radiological results in 58 hip joints of 42 patients were assessed with a follow-up time of 5.9 years on average (2.8 to 11.0 years). Although some combined procedures were carried out in only an small number of cases, we can still draw some conclusions. The results were better, if a pelvic osteotomy and an intervention on the iliopsoas muscle were performed. An additional iliopsoas transfer made the hip joints more stable over the long term than lengthening. For severely deformed acetabula the Pemberton osteotomy was superior to the Chiari osteotomy. The Salter osteotomy was a good alternative in cases with mild subluxation. With some combined procedures the redislocation rate was as high as 66%, whereas the combination of an open reduction, a femoral osteotomy, an iliopsoas transfer and a Pemberton or Salter osteotomy gave a redislocation rate of only 11%. A concentric reduction of the hip joints was necessary. Primarily noncentered joints did not improve during the later course.
对痉挛性脑瘫患者髋关节脱位或半脱位的手术修复进行了一项回顾性研究，以确定复发率最低的手术方法。在大多数情况下，切开复位和股骨截骨术与不同的骨盆截骨术以及对髂腰肌的不同干预措施相结合。对42例患者的58个髋关节的放射学结果进行了评估，平均随访时间为5.9年（2.8至11.0年）。尽管某些联合手术仅在少数病例中实施，但我们仍能得出一些结论。如果进行骨盆截骨术和对髂腰肌的干预，结果会更好。额外的髂腰肌转移术使髋关节在长期内比延长术更稳定。对于严重畸形的髋臼，潘伯顿截骨术优于恰里截骨术。在轻度半脱位的病例中，索尔特截骨术是一个不错的选择。某些联合手术的再脱位率高达66%，而切开复位、股骨截骨术、髂腰肌转移术与潘伯顿或索尔特截骨术相结合的再脱位率仅为11%。髋关节的同心复位是必要的。最初未居中的关节在后期病程中并无改善。
