脳性麻ひ児の内旋歩行に対し大腿骨減捻骨切り術と下肢短縮筋群解離術を行なった１０例の検討

Abstract

Proximal femoral derotational osteotomy was performed bilaterally on 10 children who had spastic diplegia with internal rotation gait, in combination with simultaneous multiple operations for soft tissue contractures of the lower extremities.The degree of derotation was determined intraoperatively and about 10° internal rotation at the hip was expected after surgery. Soft tissue release was followed about 4 weeks after osteotomy.The mean age at operation was 6 (4-10) years.The average follow-up was 1 year and 11 months (4 months-5 years).The average femoral anteversion was preoperatively 62° (55-70°) and improved to 24° (0-50°) in the final examination.The average derotation measured intraoperatively was 56° (45°-70°) and the average internal rotation at the hip reduced from 77° (55°-105°) to 32° (15°-50°) with a similar increase in external rotation after operation. All patients except one showed improvement of the internal rotation gait.One showed a mild recurrence of the unilateral internal rotation gait.The average time to regain preoperative ambulatory status was 5.3 (3.5-9) months. No children got worse in terms of walking ability.We realized that derotational osteotomy is necessary for correcting internal rotation gait in addition to soft tissue release.