综合矫治麻痹性髋关节失稳42例

Comprehensive correction of the instability of paralytic hip in 42 cases

目的 探讨综合性矫治手术治疗麻痹性髋关节失稳的效果。方法 术前、术后摄X线片测量髋臼深度、倾斜度、股骨头包容程度及前倾角、颈干角 ;并根据病理改变分类 ,选择手术 ,轻度采用骨盆截骨延长术 ,中度采用骨盆截骨延长加盖成形术 ,重度采用髂骨截骨及股骨转子间截骨联合手术。骨性手术同时辅以骶棘肌代臀肌或腹外斜肌代臀中肌的肌力重建。结果 4 2例经 2 1～ 4 3个月随访 ,X线片示全部骨性愈合 ,术前术后髋臼深度和髋臼角变化有显著性差异 ,髋关节稳定 ,髋部有力。结论 根据X线片测量并按病理改变分类选择手术方法 ,在综合性矫治术中骨性与肌性手术同时施行是可行的。

Objective To study the clinical outcome of comprehensive surgical management of the instability of paralytic hip. Methods The depth and slope of the acetabulum, femoral head's capacity, anteverted angle and collodiaphyseal angle were measured by X ray pre and intraoperatively. Different surgical treatment was selected according to the pathological finding. Pelvis osteotomy and lengthening was performed for the mild cases, pelvis osteotomy and acetabuloplasty for moderate cases and pelvis and intertrochanteric osteotomy for the severe ones. Muscular strength reconstruction was performed simultaneously with replacement of gluteal muscle by sacrospinal muscle or middle gluteal muscle by external oblique muscle of abdomen. Results 42 cases were followed up for 21～43 months. The x ray film showed that bony union was obtained in all cases. Significant changes of the depth and angle of acetabulum were found postoperatively. The hip joints were stable. Conclusion If the surgical treatment of instability of paralytic hip is selected according to pathology classification and X ray measurement individualized, it is feasible to perform bone and muscular surgery simultaneously.