Combined Osteotomy and Soft Tissue Release for Spastic Dislocated Hip

Between August 1982 and September 1991, 48 combined one-stage approach were performed on 31 cerebral palsied patients with spastic subluixation or dislocation of the hip. The poerafion consisted of release of the adductors, psoas, and hamstrings; a femoral shortening varus derotation osteotomy; and a pericapsular pelvic osteotomy. There were 15 females and 16 males. The right nhip was involved in 22 and the left hip in 26. All patients were spastic quadriplegics who were unable to walk. The age of operafion ranged from 3 year and 6 month to 19 years and 2 months (average: 9 years and 3months). The follow-up period ranged from 2 years and 3 months to 10 years and 1 month (average: 6 years and 4 months). On clinical examinafion, painless stability of the hip joint was achieved and maintained in all but one hips. Thirty one patients who were confined to a wheelchair had better sitting balance and better perineal care. The other one patient improved to an ambulatory status. The mean arc of flexion/extension changed from 117/25 degrees preoperatively to 106/15 degrees postoperatively. The mean hip abducfion improved from 20 to 48 degrees. Radiographically, the mean acetabular index improved from 28 to 10 degrees. The mean CE angle was increased from -31 to 33 degrees. The mean migration index of Reimers improved from 76 to 6 percent postoperatively. Six cases of femoral supracondylar fracture were encountred after spica cast immobilizafion. Two hips developed premature triradiate epiphyseal closure and three hips developed avascular necrosis of the femoral heads in our early cases. Six cases had a windswept deformity. All but one hip remained anatomically reduced at the latest follow-up.

並列關鍵字

Pericapsuler acetabular osteotomy ； Spastic dislocated hip

國際替代計量

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