両側大腿骨近位を切除した脳性麻ひの一症例

Abstract

We experienced a 22-year-old man who had bilateral hip dislocations due to spastic quadriplegia. At age seven and ten, he underwent selective soft tissue release with subluxation of the hips, but failed to obtain reduction. He was admitted to our institution because he could not tolerate hip pain any more. Both hips were kept in adduction and internal rotation position on wheelchair. He could not move without severe hip pain which disrupted daily activities. X-ray finding showed bilateral hip dislocations and degenerative changes of the femoral head.For reasons that there were degenerative changes of the femoral head, a long time had passed after dislocation, and presence of severe pain, we selected proximal femoral resection-interposition arthroplasty for the hip dislocations. We operated on his left hip first, then his right hip three months later. Skin traction was not possible for his left hip after the first operation because of low back pain. So we used an external fixation to keep distance of his right hip joint and removed it after eight weeks. Five months after the operations, X-ray showed a few heterotopic bones and proximal migration of the femur but he was able to sit with no difficulty or pain.