脚長差を伴う先天股脱ペルテス病様変化に対する股関節補正および大腿骨延長併用手術 ３例の治療経験

Abstract

We reviewed a consecutive series of three cases of the combined surgical procedure of Chiari innominate osteotomy and greater trochanteric plasty followed by femoral lengthening (callotasis) for severe residual hip deformity (Kalamchi group IV) associated with a leg length discrepancy of more than 4cm due to congenital dislocation of the hip. We performed this method on two 12 year-old girls and on an 18 year-old boy and examined their results in terms of gait, spinal scoliosis, leg length discrepancy and pain as well as range of motion of the involved hip at the time of three to four years follow-up. We also evaluated surgical correction of the hip deformity using the radiological parameters of Articulo-trochanteric distance (ATD) and Acetabulum head index (AHI). Special attention was paid clinically and radiologically to the influence of femoral lengthening onto the neighboring hip joint. All cases improved in terms of pain and range of motion of the hip. Preoperative scoliosis and limp disappeared and there was a length discrepancy of less than 0.5cm in both 12 year-old cases at follow-up. However, this persisted in one 18 year-old case with residual reg length discrepancy of 1.5cm due to poor bone formation during callotasis of the femur.Radiological parameters of the hip deformity improved in all cases: the average AHI increased from 73% to 102%, and that of ATD from -23mm to +3mm postoperatively. No abnormal findings such as subluxation or joint space narrowing of the involved hip were seen during and after the femoral lengthening.