Trochanteric-sparing Proximal Femoral Resection for Arthritic Spastic Hips

被引:3
作者
Bauer, Jennifer M. [1 ]
Butler, Marjorie P. [2 ]
Schoenecker, Perry L. [7 ]
Schoenecker, Jonathan G. [2 ,3 ,4 ,5 ,6 ]
机构
[1] Univ Washington, Dept Orthopaed & Sports Med, Seattle Childrens Hosp, Seattle, WA 98195 USA
[2] Dept Orthopaed & Rehabil, Nashville, TN USA
[3] Dept Pharmacol, Nashville, TN USA
[4] Dept Pathol Microbiol & Immunol, Nashville, TN USA
[5] Dept Pediat, Nashville, TN USA
[6] Vanderbilt Ctr Bone Biol, Nashville, TN USA
[7] Vanderbilt Univ, Med Ctr, Dept Orthopaed Surg, St Louis Shriners Hosp Children, St Louis, MO USA
关键词
neuromuscular spastic hip; trochanteric-sparing proximal femoral resection; Castle resection; PAINFUL DISLOCATED HIP; CEREBRAL-PALSY; INTERPOSITION ARTHROPLASTY; VALGUS OSTEOTOMY; HEAD RESECTION; OPEN REDUCTION; REPLACEMENT; SUBLUXATION; ACETABULUM;
D O I
10.1097/BTO.0000000000000324
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Progressive hip subluxation or dislocation leading to degenerative disease, in neuromuscular disease, is a significant cause of morbidity to the patient and burden to the caretaker. Surgical salvage procedures have unpredictable success. We hypothesized that modifying the Castle-type proximal femoral resection by securing a retained greater trochanter with its musculature to the capsular arthroplasty and femoral shaft would compartmentalize the femur to decrease proximal femoral migration and heterotopic ossification (HO), thereby precluding the need for traction and HO prophylaxis while improving pain and caretaker satisfaction. The purpose of this report is to describe the novel trochanteric-sparing proximal femoral resection (TS-PFR) technique. Seventeen hips in 13 patients were treated by the TS-PFR procedure. Twelve of 13 patients experienced complete pain relief, and all had improved sitting tolerance and perineal care. These results represent an improvement from prior salvage operations, without increase in blood loss, length of stay, proximal femoral migration, or HO. One patient underwent revision for failed soft tissue envelope. A retrospective review of patients treated at 2 institutions identified those who underwent TS-PFR for arthritic spastic hip. Perioperative course, radiologic evaluation for migration and HO, and caretaker satisfaction were compared with prior published surgical techniques. The TS-PFR technique is a safe alternative to previously described spastic hip salvage procedures and may improve upon them by creating a compartment for the proximal femur that precludes the need for traction and decreases HO. The technique improves patients' pain, sitting tolerance, perineal hygiene, and caretaker satisfaction.
引用
收藏
页码:51 / 62
页数:12
相关论文
共 39 条
[1]   Proximal femoral resection-interposition arthroplasty in cerebral palsy [J].
Abu-Rajab, Rashid B. ;
Bennet, George C. .
JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, 2007, 16 (03) :181-184
[2]  
Albinana Javier, 2002, Iowa Orthop J, V22, P61
[3]   PROXIMAL FEMORAL RESECTION-INTERPOSITION ARTHROPLASTY - SALVAGE HIP-SURGERY FOR THE SEVERELY DISABLED-CHILD WITH CEREBRAL-PALSY [J].
BAXTER, MP ;
DASTOUS, JL .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1986, 6 (06) :681-685
[4]  
Berglund L, 2015, ADULT HIP HIP PRESER
[5]   Determinants of hip pain in adult patients with severe cerebral palsy [J].
Boldingh, EJK ;
Jacobs-van der Bruggen, MAM ;
Bos, CFA ;
Lankhorst, GJ ;
Bouter, LM .
JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B, 2005, 14 (02) :120-125
[6]   ECTOPIC OSSIFICATION FOLLOWING TOTAL HIP-REPLACEMENT - INCIDENCE AND A METHOD OF CLASSIFICATION [J].
BROOKER, AF ;
BOWERMAN, JW ;
ROBINSON, RA ;
RILEY, LH .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1973, A 55 (08) :1629-1632
[7]  
BULY RL, 1993, CLIN ORTHOP RELAT R, P148
[8]   PROXIMAL FEMORAL RESECTION-INTERPOSITION ARTHROPLASTY [J].
CASTLE, ME ;
SCHNEIDER, C .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1978, 60 (08) :1051-1054
[9]   HIP DISLOCATION IN SPASTIC CEREBRAL-PALSY - LONG-TERM CONSEQUENCES [J].
COOPERMAN, DR ;
BARTUCCI, E ;
DIETRICK, E ;
MILLAR, EA .
JOURNAL OF PEDIATRIC ORTHOPAEDICS, 1987, 7 (03) :268-276
[10]   Proximal femoral resection without post-operative traction for the painful dislocated hip in young patients with cerebral palsy [J].
Dartnell, J. ;
Gough, M. ;
Paterson, J. M. H. ;
Norman-Taylor, F. .
BONE & JOINT JOURNAL, 2014, 96B (05) :701-706