骨盆倾斜的分型治疗（附295例报告）

骨盆倾斜以畸形演变机制为基础,结合临床表现分为三个类型,即髋关节周围挛缩型,下肢不等长和脊柱型。作者从1977年起对295例骨盆倾斜进行了分型治疗,其中在髋关节周围挛缩型中,轻型17例,重型58例,在下肢不等长型中,代偿性骨盆倾斜194例,固定型骨盆倾斜7例,骨盆倾斜基本纠正。在脊柱型19例中,骨盆倾斜得到明显改善。     

臀肌挛缩伴骨盆倾斜症的发病机制及治疗

目的：分析伴骨盆倾斜的臀肌挛缩症的发病机制,。以此指导临床治疗,方法（1）1990年1月－2000年1月共收治臀肌挛缩症病人143例,其中伴骨盆倾斜患者31例,全部行手术治疗。术中重点探查臀大肌,臀中肌的挛缩情况并视具体情况行松解或肌腱延长术。（2）观察,分析臀部肌内解剖以探讨臀肌挛缩症病人发生骨盆倾斜的机制,结果：（1）经随访,手术后除1例遗留轻微踊行,1例遗留约6度骨盆倾斜外,余病人均步态正常,骨盆倾斜消失,达到临床治愈。（2）结合解剖学观察及术中所见,认为单纯臀大肌挛缩不会导致骨盆倾斜,臀中肌挛缩才会导致骨盆倾斜。结论：臀中肌挛缩是伴骨盆倾斜的臀肌挛缩症病人的发病机制,对此类病人只要早发现,治疗方法正确,均能取得良好的效果。     

改良式骨盆悬吊术治疗脊髓灰质炎后遗骨盆倾斜（附40例报告）

脊髓灰质炎后遗髂胫束挛缩致患侧骨盆倾斜,髋膝关节屈曲、外展畸形,假长跛行。手术方法采用骨盆悬吊术（Axer法）,经随访发现胸盆稳定不足。用改良术式旨在发挥盆上提肌组力量,方法为髂胫束条反转穿过肋骨编织后,再与髂肋肌、背阔肌、腰背筋膜束,相互编织,紧缩。正反二组动力协调增加胸盆稳定。自1988年11月~1993年12月用改良术式治疗40例。随访35例,平均随访2.5年,优良率达91%。认真掌握手术适应证和关节畸形矫正,有利于提高疗效。     

臀肌挛缩合并骨盆倾斜肢体不等长的诊治

目的探讨儿童臀肌挛缩合并骨盆倾斜肢体不等长的发病机制、诊断和治疗方法。方法回顾性分析自1990～2004年间笔者收治的32例臀肌挛缩合并骨盆倾斜双下肢不等长患儿的临床特点并随访其疗效。结果17例双下肢长度差在0.5～2.0cm之间,9例在2.0～4.0cm之间,6例在4.0cm。所有病例均表现为不对称性的臀肌挛缩。采用经大转子后外侧纵弧形切口行臀肌松解术配合双下肢皮肤牵引、运动锻炼治疗,疗效优30例,良2例。结论臀肌挛缩合并骨盆倾斜双下肢不等长是双下肢臀肌挛缩程度不对称的结果。采用大转子后外侧纵弧形切口行臀肌松解术配合双下肢皮肤牵引、运动锻炼治疗,是臀肌挛缩合并骨盆倾斜双下肢不等长的有效治疗办法。     

臀肌挛缩症致骨盆倾斜合并肢体不等长的手术治疗

目的：揭示臀肌挛缩症合并肢体不等长的原因,并阐述手术治疗配合术后功能锻炼的方法,观察其疗效。方法：对１２８０例臀肌挛缩症患者进行临床检查分析,发现有２１２例因骨盆倾斜合并下肢肢体不等长,治疗采用臀部“Ｚ”型松解延长、配合术后下肢皮肤牵引、摆动髋部等功能锻炼。结果：术后随访３月～２年,对其临床体征等全面评估,优２０６例,良６例,优良率１００％,治愈率９９．３％。结论：此方法对诊断明确的患者治疗,既解决了臀肌挛缩平的一般症状体征,又解决了因骨盆倾斜造成的肢体不等长问题,尤其应引起临床重视和应用。     

髋关节结核致短肢畸形继发骨盆倾斜的手术治疗

目的 :探讨髋关节结核致短肢畸形继发固定性骨盆倾斜的手术治疗。方法 :应用骨盆均衡术治疗该类患者 7例。结果 :术前足跟不落地 9～ 12cm ,平均 10 2cm ,术后足跟全部落地持重。术前骨盆倾斜度 12～ 2 3 5° ,平均 16 3° ,术后 0～ 8° ,平均2 3° ,纠正率 85 2 %。结论 :骨盆均衡术是治疗髋关节结核致短肢畸形继发骨盆倾斜的一种有效方法。     

中医中药治疗骨盆创伤

自 198 1年 5月始 ,采用手法整复 ,下肢牵引加中药治疗骨盆创伤 10 6例 ,疗效良好 ,报告如下 :1　临床资料1.1　一般资料本组 10 6例 ,男 87例 ,女 19例 ,年龄 9～ 76岁。 2 1岁以下18例 ,2 1～ 40岁 6 5例 ,41岁以上 2 3例 ;致伤原因 :坠落伤 42例 ,重物砸伤 2 3例 ,挤压伤 12例 ,车祸 2 9例 ,43例合并他处骨折 5 1处 ,大关节脱位 5处 ,合并不同程度的休克 36例 ,尿道或 /和膀胱损伤 16例 ,合并血气胸 6例。1.2　分型Ⅰ型 45例 ( 4 2 .5 %) ,Ⅱ型 31例 ( 2 9.2 %) ,Ⅲ型 2 6例 ( 2 4.5 %) ,Ⅳ型 4例 ( 3.8%) ,Ⅱ型中 13例存在一侧骶髂关节…     

儿童臀肌挛缩症并骨盆倾斜的手术治疗

目的探讨儿童臀肌挛缩症并骨盆倾斜的手术治疗方法及疗效。方法臀部挛缩组织切断松解或延长术(29例)、臀肌起点下移术(11例)治疗儿童臀肌挛缩症并骨盆倾斜。结果40例术后平均随访5年,采用臀部挛缩组织松解或延长术29例中,臀肌挛缩体征及骨盆倾斜完全消失24例,部分改善3例,2例无明显改善。臀肌起点下移术11例中,臀肌挛缩及骨盆倾斜症状完全消失9例,部分改善2例。结论经臀肌大转子顶端的小切口进行臀部挛缩组织切断松解或者延长手术,对治疗轻症臀肌挛缩症并骨盆倾斜简便、有效;而臀肌起点下移术是治疗儿童重症臀肌挛缩并骨盆倾斜的有效方法。     

A new pelvic rod system for the surgical correction and fixation of pelvic obliquity in pediatric neuromuscular scoliosis

Purpose  

To describe surgical outcomes using the new device in pediatric neuromuscular scoliosis.     

Simultaneous progression patterns of scoliosis,pelvic obliquity,and hip subluxation/dislocation in non-ambulatory neuromuscular patients: an approach to deformity documentation

Background

A triad of deformities—thoracolumbar scoliosis, pelvic obliquity, and femoral head (hip) subluxation/dislocation—occurs frequently in non-ambulatory neuromuscular patients, but their close inter-relationship is infrequently appreciated or quantified. We propose a deformity documentation approach to assess each component simultaneously.

Methods

The documentation assesses each component for maximal functional level, deformity, and flexibility/rigidity: deformity from antero-posterior radiographs (scoliosis—maximal functional position, pelvic obliquity—sitting, hip position—supine) and flexibility/rigidity from extent of repositioning on supine (spine, pelvis) and frog lateral (hip) radiographs. The approach was applied in 211 patients: Duchenne muscular dystrophy (110), spinal muscular atrophy (49), cerebral palsy (26), and other neuromuscular disorders (26).

Results

Measurement of 2124 radiological data points allowed for deformity (mild to moderate to severe) and flexibility/rigidity (fully reducible to partially to non-reducible) gradations for scoliosis, pelvic obliquity, and hip subluxation/dislocation. The charting documented: (1) numerical deformity and flexibility/rigidity changes [x-axis: age; y-axis: angulation (scoliosis and pelvic obliquity) and percent coverage (hip subluxation or dislocation) from 0–120]; and (2) grade deformity and flexibility/rigidity changes [x-axis: age; y-axis: deformity and flexibility/rigidity, following conversion of numerical measurements to a 1–5 grade scale]. In subgroups with the most extensive documentation, thoracolumbar and lumbar scoliosis extended into the sacrum with 98 % (114/116) accompanied by pelvic obliquity; and scoliosis developed more rapidly than hip deformity in 44 % (28/63), scoliosis and hip deformity developed at the same time in 40 % (25/63), and hip deformity developed more rapidly than scoliosis in 16 % (10/63) (Pearson’s chi-squared test p = 0.0501, almost significant).

Conclusion and significance

Documentation of the triad of neuromuscular deformities is applicable to all diagnoses; it outlines maximal functional level, deformity, and flexibility/rigidity at each site; and it shows the relationship between spine, pelvic, and hip deformation. Prospective charting will enhance both clinical management and clinical research into neuromuscular deformity.     

Effect of pelvic obliquity on the orientation of the acetabular component in total hip arthroplasty

In infrapelvic obliquity, coronal pelvic malrotation entails a change in the spatial location of the bony acetabulum. In the present study, 77 patients presented with infrapelvic obliquity with types 1 and 2 hip pathologies in which the pelvis is lower and higher, respectively, on the short-leg side. The 2 types were classified into 3 subtypes (A, B, and C) according to the severity of the pelvic obliquity (0°-3°, 3°-6°, and >6°). Angles of inclination of pelvic obliquity postoperatively, anteversions, and inclinations (abduction angle) for acetabular components were measured after total hip arthroplasty. Increased inclination (mean, 8.79°) was observed in type 1C, where the angle of inclination to pelvic obliquity postoperatively was minimally corrected. This increase may lead to cup instability. Rebalancing the pelvis in these cases with preoperative skeletal traction and/or sufficient release of hip contractures may be necessary. A correction of the mean inclination of the cup by 8.79° is required.     

单侧臀肌挛缩症伴骨盆倾斜临床分析

目的 :探讨臀肌挛缩症并发的骨盆倾斜的诊断特点及临床治疗效果。方法 :2 4例单侧臀肌挛缩症均采用挛缩带切断术 ,术后立即用宽绷带绑扎双下肢于并膝位 ,回病房后膝下垫软枕于屈髋 45°～ 60°,屈膝 3 0°左右。拆线后 2～ 3 d下地进行并膝下蹲活动及大腿交叉架腿锻炼 ,维持 2～ 3个月。结果 :随访 2 4例 ,2 2例痊愈 ;步态正常 ,骨盆倾斜消失。2例好转 ,步态正常 ,骨盆倾斜减轻 ,双下肢脐踝距不等长 ,相差 1cm左右。结论 :单侧臀肌挛缩症伴骨盆倾斜 ,多由于臀中、小肌挛缩带引起髋关节外展畸形导致负重力线的改变所致。 2 4例患者均采用挛缩带切断术 ,具有手术操作简便 ,手术范围小 ,术中出血少 ,术后效果良好等优点     

小儿麻痹后遗成年人骨盆倾斜的分型和术式选择

目的 提出小儿麻痹后遗成年人骨盆倾斜的新分型,依据不同类型探讨手术适应证和选择简单有效的手术方式。方法 报告 56例小儿麻痹后遗成年人骨盆倾斜,根据患者致畸原因、步态和骨盆 X线片特征,将骨盆倾斜分为两型三类,应用六种手术方法予以矫正。结果 术后随访 10个月～ 6年 8个月,平均 2年 4个月。完全矫正者 11例,大部分矫正者 45例,平均矫正率 78.3％。结论 小儿麻痹后遗的成年人骨盆倾斜,不是每例患者皆适合手术治疗,新的分型有利于指导选择正确的手术方法,提高治疗效果。     

Operative treatment of neuropathic pelvic obliquity

Summary Neuropathic fixed pelvic obliquity remains an important orthopedic problem. The three known methods for operative correction of this deformity are described. The combined VDS and Harrington method is described in this paper, along with its advantages. The combined operation corrects kyphosis, lordosis, and scoliosis and offers immediate stability of the spine with good correction of the fixed pelvic obliquity.

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Zusammenfassung Der neuropathische kontrakte Beckenschiefstand bleibt im Rahmen der Skoliosebehandlung ein großes orthopadisches Problem. Drei der bekanntesten Methoden zur operativen Korrektur der Skoliose mit kontraktem Beckenschiefstand werden dargestellt. Auf die operative Behandlung mit der Kombination von VDS and Harrington wird im Detail eingegangen and die Vorteile dieses Verfahrens werden unterstrichen. Die kombinierte Operation korrigiert gleichzeitig die kypho-lordo-skoliotische Deformitat and den Beckenschiefstand. Damit wird Stabilitat and bessere Korrektur durch vordere und hintere Fusion bei statisch lotgerechter Einstellung neben weitgehender Korrektur des kontrakten Beckenschiefstandes erreicht.

     

Operative treatment of neuropathic pelvic obliquity

Neuropathic fixed pelvic obliquity remains an important orthopedic problem. The three known methods for operative correction of this deformity are described. The combined VDS and Harrington method is described in this paper, along with its advantages. The combined operation corrects kyphosis, lordosis, and scoliosis and offers immediate stability of the spine with good correction of the fixed pelvic obliquity.     

Second-generation cephalomedullary nails in the treatment of reverse obliquity intertrochanteric fractures of the proximal femur

Since 1996, in Tampere University Hospital, a second-generation cephalomedullary nail (CMN) has been the implant of first choice in reverse obliquity fractures of the proximal femur. Between 1996 and 1999 we treated 77 such fractures, of which 72 were fixed with the CMN. There were six re-operations (8.3%). An anatomic or nearly anatomic reduction and a properly placed implant were found in 47 cases with one failure. An unacceptable postoperative radiological result was seen in 25 cases resulting in five re-operations (P=0.029). In 12 of 14 open procedures a cable was added to stabilise the greater trochanter and none failed. Four of five fractures fixed with the sliding hip screw failed. Our results using the CMN in reverse obliquity intertrochanteric fractures compares favourably to the results in earlier reports where extramedullary implants are used.     

严重骨盆骨折的救治及手术治疗

目的报道严重骨盆骨折的治疗经验,以期进一步提高其早期诊断和救治水平。方法回顾性分析总结了1994年4月～2002年3月106例严重骨盆骨折的临床资料。结果骨盆骨折主要的致伤原因为交通事故伤(69例,占65.1%)及坠落伤(31例,占29.3%)。106例中,87例生存,19例死亡,死亡率为17.9%,其中10例死于出血性休克,4例死于严重脑外伤,3例死于多器官功能衰竭,2例死于急性呼吸窘迫综合征。其中骨盆骨折手术治疗32例,优良率达91.7%。结论严重骨盆骨折救治中院前急救十分重要,要及时处理严重合并伤,积极行骨盆骨折内固定手术。