摘要:

The hip joint is fully developed at the eleventh gestational week. This is the earliest time at which dislocation can occur because only a concentrically congruent femoral head in the acetabulum can lead to development of a normal hip joint. If normal development does not occur, treatment is required as soon as possible. In the first months of life, simple means of physiologic abduction should be used. If maintenance of reduction is impossible by these means, gentle closed reduction should be performed. Open reduction of the hip joint is reserved for hips in which obstacles to gentle closed reduction exist or hips that do not respond to conservative treatment. Open reduction is recommended from age 6 months; after age 18 months, subtrochanteric varus derotational or Salter's innominate osteotomy should be performed, according to the bony changes on the femoral or pelvic side of the hip joint.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We use varus-extension osteotomy (VEO) to treat patients with Legg-Calvé-Perthes' disease (LCPD) aged ≥5 years who have >50% of femoral head involvement. Based on our study and results from the literature, we argue that this operation should be undertaken before femoral head deformity occurs and as soon as possible after diagnosis. We suggest that it is more appropriate to contain the head by varus and extension rather than derotation.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To improve the amount of varization and medial displacement of the femoral neck, we performed a modified femoral varization osteotomy in 31 paralytic hips. Pushing the blade plate directly through the proximal osteotomy surface into the femoral neck simplifies the surgical technique, diminishes hardware protrusion, and allows significant medial displacement. At an average follow-up of 19 months, a retrospective study of 22 hips showed consolidation in all cases with no sign of necrosis of the femoral head despite significant varization and subperiosteal dissection of the femoral neck. Our results suggest that the modified varization technique produces good results in paralytic hips, with no recurrence of femoral valgus at last follow-up.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In a group of 40 children with cerebral palsy (CP), myelomeningocele, or sequelae of previous tenotomy and neurotomy, a specific surgical approach was used to correct various type of hip disorders: migrating hip, subluxated or luxated hip, compressed hip, and windblown hip, especially in quadriplegia. Osteotomy is performed at the intertrochanteric area, where a segment of femur (3–5 cm) is removed and the lesser trochanter is released, allowing the psoas muscle to reinsert in a more proximal position. Based on the concept of imbalance between predetermined bone growth and passive adaptation of muscles, we postulated in 1982 that a reduction in bone length should have an effect on surrounding muscles, allowing them the possibility of working in better anatomic conditions. With our procedure, we obtain major release of muscle tension around the hip—release of hamstring, psoas, and tensor of fascia lata—and consequently a wide range of passive motion of the hips as well as the knees. Long-lasting effects are preserved only by use of regular splinting for a prolonged time. In hip luxation, reduction can be obtained by this extraarticular approach, without need to open the joint. A pelvic procedure is performed only when the acetabulum shows marked changes. In five children with CP, the procedure was combined with shortening of the patellar tendon to reactivate the extensor mechanism of the knees. We consider this specific approach a safe procedure that leaves the neural anatomy undisturbed and allows early ambulation, usually at 4 weeks. It may be used as a salvage procedure and as the initial treatment step for various neurologic hip disorders.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Distal and lateral transfer of the greater trochanter for overgrowth is performed much more often than is described in the English literature. We used this procedure as a preventive measure to eliminate further deterioration of the proximal femoral growth plates in cases of greater trochanteric overgrowth. Our experience with this procedure in 12 children showed overall good results.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We reviewed radiographs of 22 hips in 22 children treated by Pemberton and Salter osteotomies for acetabular dysplasia. The average age of patients at operation was 4 years 5 months. We measured changes in AC and center-edge angles and lateralization of the acetabular fragment on the medial side of the osteotomy. In both procedures, good lateralization was very important to the final growth of the acetabulum. Analysis of results showed that good containment of the femoral head was achieved only when the position of the outer edge of the acetabulum was changed so that it was beyond the point of maximal pressure of the femoral head, preventing pressure on the acetabular growth zone.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The term “lateral acetabular osteotomy” means that unlike in Pemberton and Salter procedures osteotomy of the acetabular roof is directed from the lateral extracapsular rim in a medial direction. Controlled by fluoroscopy, the surgeon should chisel bone to the most medial and posterior part of the triradiate cartilage, but stop 3 mm before reaching it. After complete osteotomy is performed from the sciatic notch to the anteroinferior iliac spine, the acetabular roof can be turned down separately to a normal angle. Therefore, the joint obtains its normal radius and stability immediately. Even extremely shallow acetabuli can be treated successfully as long as the cartilage is not consolidated. Follow-up investigations until the end of growth in 90 hip joints have shown that acetabular measurements were normal or slightly pathologic in 82–93% of patients according to our grading system of normal values and degrees of deviation. When varus osteotomy was performed simultaneously, measurements of femoral neck and head were normal to slightly pathologic in only 47–50%. For this reason, we have avoided varus osteotomies in the last decade. No complications have occurred at the triradiate cartilage.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A spherical rotational osteotomy performed close to the acetabulum to correct acetabular dysplasia in adolescents and young adult patients was described by Wagner in 1965. Since 1980, we have used the anterior surgical approach of Smith-Petersen and special spherical chisels as our operative technique. Stable internal fixation with modified semitubular plates allows early functional postoperative treatment without external immobilization. Adherence to strict surgical indications has yielded good results with few complications and infrequent need for revision surgery. Results from three series of spherical osteotomies (>300 hips) validate the concept of major acetabular redirection for improvement of prognosis in adolescents and young adult patients with moderate and severe congruous acetabular dysplasia.

ISSN:0271-6798    

出版商:OVID    

年代:1994

数据来源: OVID