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小兒의 痲痺性 股關節에 대한 再建術 Reconstruction of Paralytic Hips in Children

대한정형외과학회지 1976년 11권 4호 p.639 ~ 655
金仁權, 李德鏞,
소속 상세정보
金仁權 (  ) 
서울대학교 醫科大學 整形外科學校室

李德鏞 (  ) 
서울대학교 醫科大學 整形外科學校室

Abstract


The approach toward paralytic hips in children with subluxation or dislocation has .been essentially conservative. and palliative, frequently accepting the subluxation or dislocation. Buster Brown belt, ischial seat brace, or crutches with non-weight bearing is .frequently prescribed. For obvious reasons, both the patient and the surgeon are reluctant to resort to hip fusion, and muscle or tendon transfer about the hip cannot be expected to function in the presence of subluxation or dislocation.
On the other hand, deformities about the´ hip are corrected successfully by standard procedures, such as adductor tenotomy, Soutter´s fasciotomy, and Campbell´s iliac crest transfer. In severe, fixed deformities in older children, the overall balance may-be restored by varus or valgus osteotomy of Irwin, leaving the deformities uncorrected.
Jones´ varus osteotomy is aimed at reduction of the hip, but it ignores the factor of remodeling and is of temporary benefit. More recently, Salter´s and Pemberton´s osteotomies have been suggested in the treatment of paralytic subluxation or dislocation, but the lack of remodeling remains unchallenged.
During the period of 14 years, from October 1963 to May 1976, yve operated on 132 hips in 10$ cases of paralytic hips, mostly in children, at Seoul National University Hospital.
Of the total cases, 104 cases were residual poliomyelitis, 3 cases cerebral palsy, and one case meningomyelocele. Operative procedures carried out on these hips were as follows: Soutter´s abductor fasciotomy; 35
Camlpbel~´s iliac crest transfer; 22
Lumbodorsal fasciotomy; 20
Ober-Barr´s erector spinae and tensor fasciae latae transfer; 29
Thomas-Thompson-Straub´s external oblique transfer; 15
Sharrard´s iliopsoas transfer; 6
Mustard´s iliopsoas transfer; 20
Legg-Dickson´s tensor fasciae latae transfer; 8
Bleck´s iliopsoas recession; 1
Hip fusion; 2
Pemberton´s pericapsular osteotomy; 28
Salter´s innominate osteomy; 26
Steel´s triple osteotomy: 1
Chiari´s osteomy: 1
Soft tissue release operations were carried out whenever necessary, either prior to or at the time of reconstructive surgery. In 39 hips, osteotomies were either combined at the same time or were followed by muscle or tendon tra~}sfers, while in the earlier 4 hips osteotomy alone resulted in recurrence of subluxation or dislocation and required repeat osteotomy combined with muscle transfer, and in another hip, recent!, osteotomy was complicated by infection and muscle transfer has been postponed to date.
In our experience with paralytic hips, when subluxation or dislocation is present, either muscle or tendon transfer alone or osteotomy or arthroplasty alone will likely fail or, at best, will be ineffective. Most satisfactory and` permanent results were obtained when these hips were aggressively treated by maximum correction of deformities followed by combined mechanical osteotomy or arthroplasty) and functional (muscle or tendon transfer) stabilizations. This often permits elimination of the brace and hip fusion is seldom necessary, thus resulting in functional salvage . of a flail hip. Also, any surgery on the knee and the foot of the same limb is greatly enhanced by reconstruction of the hip.

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